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General NPI Number Information
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NPI Number | 1629359864
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Entity Type | Organization
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Legal Business Name | CALIFORNIA EMERGENCY PHYSICIAN MEDICAL GROUP
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 09/01/2011
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Provider Practice Location Address
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Address Line | 615 W LINCOLN AVE
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City | MONTEBELLO
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State | CA
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Zip | 90640-3528
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Country | US
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Telephone | 323-727-0205
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Fax |
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Provider Business Mailing Address
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Address Line | 615 W LINCOLN AVE
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City | MONTEBELLO
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State | CA
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Zip | 90640-3528
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Country | US
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Telephone | 323-727-0205
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Fax |
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Authorized Official
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Title or Position | MID LEVEL PRACTITIONER
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Name | KIM YEN PHAM
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Credential | PA-C
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Telephone | 323-727-0205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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