MEDICARE: HUDSON 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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1275871436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDSON MEDICAL GROUP

Provider Business Mailing Address
First Line	:	530 S LAKE AVE # 451
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-3515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 S LAKE AVE # 451
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-3515
Country	:	US
Telephone Number	:	888-777-6636
Fax Number	:	626-408-6624

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	PETER CHANG
Credential	:
Telephone Number	:	888-777-6639

Provider Enumeration Date	:	01/23/2013
Last Update Date	:	01/23/2013

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