=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528163334
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH BAY ALLERGY & ASTHMA ASSOC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 12/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20911 EARL STREET 301
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-371-1388
-----------------------------------------------------
Fax | 310-371-3439
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20911 EARL STREET 301
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-371-1388
-----------------------------------------------------
Fax | 310-371-3439
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. EDWARD G BUCHBAUM
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-371-1388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------