Healthcare Provider Details

I. General information

NPI: 1043648322
Provider Name (Legal Business Name): J CHRISTOPHER MATCHISON, MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 LOMITA BLVD STE 235
TORRANCE CA
90505-5111
US

IV. Provider business mailing address

2841 LOMITA BLVD STE 235
TORRANCE CA
90505-5111
US

V. Phone/Fax

Practice location:
  • Phone: 310-517-8950
  • Fax: 310-326-6080
Mailing address:
  • Phone: 310-517-8950
  • Fax: 310-326-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA97926
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA97926
License Number StateCA

VIII. Authorized Official

Name: CATHERINE CHOI
Title or Position: PROGRAM MANAGER
Credential:
Phone: 310-517-8951