Healthcare Provider Details

I. General information

NPI: 1609893619
Provider Name (Legal Business Name): SOUTH BAY GASTROENTEROLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23456 HAWTHORNE BLVD STE 300
TORRANCE CA
90505-4716
US

IV. Provider business mailing address

23456 HAWTHORNE BLVD STE 300
TORRANCE CA
90505-4716
US

V. Phone/Fax

Practice location:
  • Phone: 310-539-2055
  • Fax: 310-539-0199
Mailing address:
  • Phone: 310-539-2055
  • Fax: 310-539-0199

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. OREN ZAIDEL
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 310-539-2055