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General NPI Number Information
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NPI Number | 1285173336
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Entity Type | Organization
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Legal Business Name | COORDINATED CARE MEDICAL GROUP
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 711 W COLLEGE ST SUITE 388
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City | LOS ANGELES
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State | CA
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Zip | 90012-1163
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Country | US
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Telephone | 213-437-4216
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Fax |
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Provider Business Mailing Address
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Address Line | 711 W COLLEGE ST SUITE 203
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City | LOS ANGELES
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State | CA
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Zip | 90012-1163
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/SECRETARY/TREASURER
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Name | TIT LI
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Credential | M.D.
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Telephone | 213-427-4380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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