MEDICARE: BIXBY MEDICAL CENTER 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	261Q00000X	Clinic/Center	20A14256	CA

General Provider Information

NPI Number	:	1861910515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIXBY MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	3711 LONG BEACH BLVD STE 200
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3319
Country	:	US
Telephone Number	:	562-980-0555
Fax Number	:

Provider Business Practice Location Address
First Line	:	3711 LONG BEACH BLVD STE 200
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3319
Country	:	US
Telephone Number	:	562-980-0555
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. DON QUI PHAM
Credential	:	DO
Telephone Number	:	786-371-4455

Provider Enumeration Date	:	09/01/2017
Last Update Date	:	07/21/2022

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