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General NPI Number Information
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NPI Number | 1831017227
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Entity Type | Organization
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Legal Business Name | SENIOR SUPPORT MEDICAL GROUP PC
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Dates
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Enumeration Date | 07/06/2026
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Last Update Date | 07/07/2026
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Provider Practice Location Address
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Address Line | 880 APOLLO ST STE 217
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City | EL SEGUNDO
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State | CA
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Zip | 90245-4752
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Country | US
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Telephone | 714-698-4908
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Fax | 714-698-4908
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Provider Business Mailing Address
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Address Line | 880 APOLLO ST STE 217
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City | EL SEGUNDO
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State | CA
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Zip | 90245-4752
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Country | US
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Telephone | 714-698-4908
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Fax | 714-698-4908
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK SHEN
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Credential | MD
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Telephone | 714-698-4908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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