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General NPI Number Information
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NPI Number | 1821325523
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Entity Type | Organization
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Legal Business Name | ISABEL MEDICAL GROUP,INC
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Dates
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Enumeration Date | 11/17/2009
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 4407 S MAIN ST
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City | LOS ANGELES
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State | CA
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Zip | 90037-2731
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Country | US
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Telephone | 323-231-0106
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Fax | 323-231-6351
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Provider Business Mailing Address
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Address Line | 4407 S MAIN ST
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City | LOS ANGELES
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State | CA
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Zip | 90037-2731
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Country | US
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Telephone | 323-231-0106
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Fax | 323-231-6351
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Authorized Official
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Title or Position | SECRETARY
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Name | EDWARD BUI HAI
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Credential | MD
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Telephone | 323-231-0106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A36092
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License Number State | CA
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