MEDICARE: BEACH CITIES MEDICAL GROUP

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	261QA1903X	Ambulatory Surgical Clinic/Center	16520 AAAHC,INC	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16520	OTHER	CA	ACCREDITATION ASSOCIATION FOR AMBULATORY HEALTH CARE, INC.

General Provider Information

NPI Number	:	1205161395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH CITIES MEDICAL GROUP

Provider Business Mailing Address
First Line	:	4210 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2802
Country	:	US
Telephone Number	:	562-595-8507
Fax Number	:	562-988-9220

Provider Business Practice Location Address
First Line	:	4210 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2802
Country	:	US
Telephone Number	:	562-595-8507
Fax Number	:	562-988-9220

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	NIKOLAS V CHUGAY
Credential	:	D.O.
Telephone Number	:	562-595-8507

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	08/05/2011

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Directions to “BEACH CITIES MEDICAL GROUP ” Practice Location

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