Healthcare Provider Details

I. General information

NPI: 1578914446
Provider Name (Legal Business Name): CALIFORNIA ADDICTION MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6331 GREENLEAF AVE STE G
WHITTIER CA
90601-3553
US

IV. Provider business mailing address

15243 LA CRUZ DR 652
PACIFIC PALISADES CA
90272-3616
US

V. Phone/Fax

Practice location:
  • Phone: 310-871-3434
  • Fax: 206-202-4724
Mailing address:
  • Phone: 310-871-3434
  • Fax: 206-202-4724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberG029768
License Number StateCA

VIII. Authorized Official

Name: DR. STEVEN KAYE
Title or Position: CEO
Credential: MD
Phone: 310-871-3434