Healthcare Provider Details

I. General information

NPI: 1275031957
Provider Name (Legal Business Name): CORUM ANESTHESIOLOGY GROUP, PC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 CRENSHAW BLVD
TORRANCE CA
90501-2433
US

IV. Provider business mailing address

21213B HAWTHORNE BLVD STE 101
TORRANCE CA
90503-5501
US

V. Phone/Fax

Practice location:
  • Phone: 310-507-9171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID WU
Title or Position: PRESIDENT
Credential: MD
Phone: 310-507-9171