Healthcare Provider Details

I. General information

NPI: 1316971351
Provider Name (Legal Business Name): PENINSULA PULMONARY MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 SKYPARK DR #200
TORRANCE CA
90505-4753
US

IV. Provider business mailing address

3701 SKYPARK DR #200
TORRANCE CA
90505-4753
US

V. Phone/Fax

Practice location:
  • Phone: 310-378-8900
  • Fax: 310-791-0786
Mailing address:
  • Phone: 310-378-8900
  • Fax: 310-791-0786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN KEITH WONG
Title or Position: PARTNER
Credential: MD
Phone: 310-378-8900