MEDICARE: SOUTHBAY FAMILY MEDICAL CLINIC

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	282N00000X	General Acute Care Hospital	19910	CA

General Provider Information

NPI Number	:	1821375965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHBAY FAMILY MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	23517 S MAIN ST.
Second Line	:	SUITE # 103
City	:	CARSON
State	:	CA
Zip	:	90745
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23517 MAIN ST
Second Line	:	SUITE # 103
City	:	CARSON
State	:	CA
Zip	:	90745-5251
Country	:	US
Telephone Number	:	310-834-5388
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. SHRIKANT TAMHANE
Credential	:	M.D.
Telephone Number	:	310-834-5388

Provider Enumeration Date	:	11/03/2011
Last Update Date	:	11/03/2011

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