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General NPI Number Information
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NPI Number | 1033537949
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Entity Type | Organization
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Legal Business Name | GRAND GI & ENDOSCOPY GROUP, INC.
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Dates
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Enumeration Date | 03/29/2014
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 505 S VIRGIL AVE SUITE 104
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City | LOS ANGELES
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State | CA
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Zip | 90020-1406
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Country | US
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Telephone | 213-381-3590
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Fax | 213-381-3593
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Provider Business Mailing Address
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Address Line | 1646 GLORIETTA AVE
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City | GLENDALE
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State | CA
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Zip | 91208-2010
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Country | US
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Telephone | 213-381-3590
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Fax | 213-381-3593
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAE SOON RHEEM
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Credential | M.D., PH.D.
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Telephone | 213-381-3590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State |
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