MEDICARE: SYNC HOSPITALIST MEDICAL GROUP APC

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	208M00000X	Hospitalist Physician	A105566	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB231384	OTHER	CA	PTAN

General Provider Information

NPI Number	:	1467826651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNC HOSPITALIST MEDICAL GROUP APC

Provider Business Mailing Address
First Line	:	325 N MAPLE DR
Second Line	:	10144
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90213-4842
Country	:	US
Telephone Number	:	310-421-8295
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 N MAPLE DR
Second Line	:	10144
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90213-4842
Country	:	US
Telephone Number	:	310-421-8295
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. JON P KEA
Credential	:	MD
Telephone Number	:	310-421-8295

Provider Enumeration Date	:	11/25/2015
Last Update Date	:	11/16/2016

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