Healthcare Provider Details

I. General information

NPI: 1699965087
Provider Name (Legal Business Name): ALLIANCE DIGESTIVE DISEASE CONSULTANTS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ALESSANDRO PL STE 410
PASADENA CA
91105-3175
US

IV. Provider business mailing address

50 ALESSANDRO PL STE 410
PASADENA CA
91105-3175
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-7114
  • Fax: 626-793-7679
Mailing address:
  • Phone: 626-793-7114
  • Fax: 626-793-7679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KALMAN JACOB EDELMAN
Title or Position: PRESIDENT/ PARTNER
Credential: M.D.
Phone: 626-793-7114