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General NPI Number Information
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NPI Number | 1871811448
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Entity Type | Organization
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Legal Business Name | HAYASA MEDICAL GROUP INC
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 3540 WILSHIRE BLVD SUITE 714
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City | LOS ANGELES
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State | CA
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Zip | 90010-2307
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Country | US
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Telephone | 213-382-2063
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Fax | 213-382-4935
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Provider Business Mailing Address
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Address Line | 3540 WILSHIRE BLVD SUITE 714
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City | LOS ANGELES
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State | CA
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Zip | 90010-2307
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Country | US
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Telephone | 213-382-2063
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Fax | 213-382-4935
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Authorized Official
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Title or Position | CEO
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Name | SAMUEL LEE DRAKE
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Credential | M.D,
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Telephone | 213-382-2063
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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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