MEDICARE: STEIN MEDICAL GROUP PC

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	207RH0003X	Hematology & Oncology Physician
2	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1144992785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEIN MEDICAL GROUP PC

Provider Business Mailing Address
First Line	:	7204 SHORELINE DR UNIT 160
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-4928
Country	:	US
Telephone Number	:	858-774-7287
Fax Number	:	702-847-6428

Provider Business Practice Location Address
First Line	:	7395 S PECOS RD STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3714
Country	:	US
Telephone Number	:	702-847-6555
Fax Number	:	702-847-6428

Authorized Official
Title or Position	:	OFFICE MANAGER/ADMINISTRATOR
Name	:	MIJA SUNG
Credential	:
Telephone Number	:	858-774-7287

Provider Enumeration Date	:	10/01/2021
Last Update Date	:	10/01/2021

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Directions to “STEIN MEDICAL GROUP PC ” Practice Location

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