MEDICARE: SOUTHERN CALIFORNIA UROLOGY 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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1730013764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN CALIFORNIA UROLOGY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	3650 SOUTH ST STE 408
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1510
Country	:	US
Telephone Number	:	562-630-0423
Fax Number	:	562-630-0660

Provider Business Practice Location Address
First Line	:	3650 SOUTH ST STE 408
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1510
Country	:	US
Telephone Number	:	562-630-0423
Fax Number	:	562-630-0660

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JONATHAN EDWARD PERLEY
Credential	:	MD
Telephone Number	:	562-355-6629

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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