MEDICARE: AFTERMATH MEDICAL GROUP, ONC.

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1770259749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFTERMATH MEDICAL GROUP, ONC.

Provider Business Mailing Address
First Line	:	2222 FOOTHILL BLVD # E122
Second Line	:
City	:	LA CANADA
State	:	CA
Zip	:	91011-1456
Country	:	US
Telephone Number	:	323-974-3211
Fax Number	:	213-389-2506

Provider Business Practice Location Address
First Line	:	2520 W 8TH ST STE 106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3861
Country	:	US
Telephone Number	:	213-389-2526
Fax Number	:	213-389-2506

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. EDWARD N OPOKU
Credential	:	D.O.
Telephone Number	:	323-974-3211

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	08/19/2021

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