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General NPI Number Information
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NPI Number | 1104813187
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Entity Type | Organization
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Legal Business Name | CANCER CARE ASSOCIATES MEDICAL GROUP INC
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 514 N PROSPECT AVE 4TH FLOOR
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3040
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Country | US
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Telephone | 310-750-3300
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Fax | 310-750-3381
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Provider Business Mailing Address
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Address Line | 514 N PROSPECT AVE 4TH FLOOR
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3040
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Country | US
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Telephone | 310-750-3300
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Fax | 310-750-3381
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Authorized Official
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Title or Position | CO OWNER PRESIDENT
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Name | DAVID CHAN
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Credential | MD
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Telephone | 310-750-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | CA
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