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General NPI Number Information
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NPI Number | 1730110495
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Entity Type | Organization
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Legal Business Name | SOUTHLAND RENAL MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 3300 E. SOUTH STREET SUITE 308
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City | LONG BEACH
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State | CA
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Zip | 90805-4598
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Country | US
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Telephone | 562-630-3111
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Fax | 562-630-3107
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Provider Business Mailing Address
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Address Line | PO BOX 879
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City | LAKEWOOD
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State | CA
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Zip | 90714-0879
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Country | US
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Telephone | 562-630-3111
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Fax | 562-630-3107
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AVEDIK SEMERJIAN
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Credential | MD, FACP, FASN
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Telephone | 562-630-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A46344
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License Number State | CA
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