MEDICARE: ACTINIUM MEDICAL CORPORATION

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	207QA0505X	Adult Medicine Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1659088714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTINIUM MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	120 W BEVERLY BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-4305
Country	:	US
Telephone Number	:	323-490-7231
Fax Number	:	323-490-7282

Provider Business Practice Location Address
First Line	:	120 W BEVERLY BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-4305
Country	:	US
Telephone Number	:	323-528-1565
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JACKSON CHEUK KI MA
Credential	:	MD
Telephone Number	:	323-528-1565

Provider Enumeration Date	:	10/28/2022
Last Update Date	:	03/30/2026

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Directions to “ACTINIUM MEDICAL CORPORATION ” Practice Location

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