=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730013764
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN CALIFORNIA UROLOGY MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2026
-----------------------------------------------------
Last Update Date | 06/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3650 SOUTH ST STE 408
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90712-1510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-630-0423
-----------------------------------------------------
Fax | 562-630-0660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3650 SOUTH ST STE 408
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90712-1510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-630-0423
-----------------------------------------------------
Fax | 562-630-0660
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | JONATHAN EDWARD PERLEY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 562-355-6629
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------