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General NPI Number Information
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NPI Number | 1598223299
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Entity Type | Organization
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Legal Business Name | GRUPO MEDICO SAN PEDRO INC
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 13939 SAN ANTONIO DR
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City | NORWALK
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State | CA
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Zip | 90650-4036
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Country | US
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Telephone | 562-807-3777
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Fax | 562-807-2333
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Provider Business Mailing Address
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Address Line | 13939 SAN ANTONIO DR
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City | NORWALK
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State | CA
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Zip | 90650-4036
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Country | US
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Telephone | 562-807-3777
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Fax | 562-807-2333
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Authorized Official
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Title or Position | MEDICAL DIRECTOR / OWNER
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Name | JOSEPH I KANG
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Credential | MD
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Telephone | 562-716-4468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology 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 | 208000000X
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Taxonomy Name | Pediatrics 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 | 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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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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