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General NPI Number Information
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NPI Number | 1144498890
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Entity Type | Organization
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Legal Business Name | EXPRESSCARE MEDICAL CLINIC INC
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 11/13/2014
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Provider Practice Location Address
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Address Line | 8930 S SEPULVEDA BLVD SUITE 200
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City | LOS ANGELES
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State | CA
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Zip | 90045-3606
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Country | US
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Telephone | 310-641-8111
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Fax | 310-337-7274
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Provider Business Mailing Address
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Address Line | 8930 S SEPULVEDA BLVD SUITE 200
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City | LOS ANGELES
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State | CA
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Zip | 90045-3606
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Country | US
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Telephone | 310-641-8111
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Fax | 310-337-7274
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SAMIR SHAHIN
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Credential | MD
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Telephone | 310-641-8111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | G53276
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G53276
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License Number State | CA
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