=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851469779
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELITE ONCOLOGY MEDICAL GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2006
-----------------------------------------------------
Last Update Date | 03/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12099 W WASHINGTON BLVD SUITE 304
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90066-5882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-398-0013
-----------------------------------------------------
Fax | 310-398-4470
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12099 W WASHINGTON BLVD SUITE 304
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90066-5882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-398-0013
-----------------------------------------------------
Fax | 310-398-4470
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JAMES I. BICHER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 310-398-0013
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A37798
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------