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General NPI Number Information
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NPI Number | 1376283614
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Entity Type | Organization
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Legal Business Name | ONE HEALTH MEDICAL GROUP INC
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 3630 E IMPERIAL HWY STE 55B
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City | LYNWOOD
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State | CA
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Zip | 90262-2609
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Country | US
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Telephone | 310-722-1108
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Fax | 310-362-8957
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Provider Business Mailing Address
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Address Line | 3630 E IMPERIAL HWY # 55B
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City | LYNWOOD
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State | CA
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Zip | 90262-2609
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Country | US
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Telephone | 310-722-1108
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Fax | 310-362-8957
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANTHONY DAVENPORT
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Credential |
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Telephone | 773-412-4653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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