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General NPI Number Information
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NPI Number | 1134364243
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Entity Type | Organization
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Legal Business Name | US MEDICAL GROUP
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Dates
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Enumeration Date | 12/04/2008
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | 8610 S. SELPULVEDA BLVD. #208
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City | LOS ANGELES
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State | CA
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Zip | 90045
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Country | US
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Telephone | 310-999-9826
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Fax | 310-909-8692
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Provider Business Mailing Address
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Address Line | P.O. BOX 84480
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City | LOS ANGELES
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State | CA
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Zip | 90073
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Country | US
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Telephone | 310-999-9826
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Fax | 310-909-8696
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DSHAIKH IZUCHUKWU
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Credential | ED
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Telephone | 310-999-9826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A80750
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License Number State | CA
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