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General NPI Number Information
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NPI Number | 1730255548
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Entity Type | Organization
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Legal Business Name | SO PASADENA OB & GYN MEDICAL GROUP
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 10 CONGRESS ST STE 403
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City | PASADENA
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State | CA
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Zip | 91105-3023
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Country | US
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Telephone | 626-577-8058
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Fax | 626-440-9976
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Provider Business Mailing Address
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Address Line | 10 CONGRESS ST STE 403
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City | PASADENA
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State | CA
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Zip | 91105-3023
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Country | US
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Telephone | 626-577-8058
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Fax | 626-440-9976
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOSEPH Y LI
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Credential | M.D.
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Telephone | 626-577-8058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146D00000X
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Taxonomy Name | Personal Emergency Response Attendant
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License Number | G40118
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License Number State | CA
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