MEDICARE: GOLD MEDICAL GROUP, INC.

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	174400000X	Specialist	G186240	CA
2	207Q00000X	Family Medicine Physician	A40133	CA
3	208000000X	Pediatrics Physician	A44512	CA
4	207R00000X	Internal Medicine Physician	A34065	CA

General Provider Information

NPI Number	:	1730136359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLD MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	1700 CESAR E. CHAVEZ
Second Line	:	SUITE #3300
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-0000
Country	:	US
Telephone Number	:	323-264-4114
Fax Number	:	323-264-4662

Provider Business Practice Location Address
First Line	:	1700 CESAR E. CHAVEZ
Second Line	:	SUITE #3300
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-0000
Country	:	US
Telephone Number	:	323-264-4114
Fax Number	:	323-264-4662

Authorized Official
Title or Position	:	OWNER
Name	:	ROSANNA ISKANDER
Credential	:	MD
Telephone Number	:	323-264-4114

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	09/01/2009

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Directions to “GOLD MEDICAL GROUP, INC. ” Practice Location

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