=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255766523
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PULMONARY, CRITICAL CARE, & SLEEP SPECIALISTS OF LONG BEACH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2013
-----------------------------------------------------
Last Update Date | 09/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23517 SOUTH MAIN STREET SUITE 103
-----------------------------------------------------
City | CARSON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90745-5234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-850-6404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2017
-----------------------------------------------------
City | GARDENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90247-0017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-850-6404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. AMJAD MUNIM
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 954-850-6404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A37820
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------