MEDICARE: SUNMOON URGENT CARE 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	W17844	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144316217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNMOON URGENT CARE MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 573
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91754-0573
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1161 1/2 LOGAN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-3210
Country	:	US
Telephone Number	:	213-484-1289
Fax Number	:	213-484-2339

Authorized Official
Title or Position	:	MD
Name	:	XIA LI
Credential	:
Telephone Number	:	213-484-1289

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	10/22/2014

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