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General NPI Number Information
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NPI Number | 1306149083
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Entity Type | Organization
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Legal Business Name | DRAYTON P GRAHAM A MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/17/2010
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 4477 W 118TH ST STE. 401
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City | HAWTHORNE
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State | CA
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Zip | 90250-2255
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Country | US
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Telephone | 310-970-1930
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Fax | 310-970-1979
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Provider Business Mailing Address
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Address Line | 4477 W 118TH ST STE 405
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City | HAWTHORNE
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State | CA
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Zip | 90250-2259
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Country | US
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Telephone | 310-970-1930
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Fax | 928-268-0107
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DRAYTON P GRAHAM JR.
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Credential | MD
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Telephone | 310-970-1930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | G27833
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | G27833
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License Number State | CA
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