MEDICARE: ST JOHN MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A52194	CA

General Provider Information

NPI Number	:	1013188721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JOHN MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	3530 LONG BEACH BLVD STE 120
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3972
Country	:	US
Telephone Number	:	562-989-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 LONG BEACH BLVD STE 120
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3972
Country	:	US
Telephone Number	:	562-989-1200
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL OFFICER
Name	:	DR. YOUSSEF AWAD
Credential	:	M.D
Telephone Number	:	909-568-6770

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	06/26/2021

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Directions to “ST JOHN MEDICAL GROUP INC ” Practice Location

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