MEDICARE: PACIFIC BAY 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	207Q00000X	Family Medicine Physician	20A5319	CA

General Provider Information

NPI Number	:	1881783462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC BAY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1403 LOMITA BLVD
Second Line	:	SUITE 304
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-2076
Country	:	US
Telephone Number	:	310-517-1828
Fax Number	:	310-517-0362

Provider Business Practice Location Address
First Line	:	1403 LOMITA BLVD
Second Line	:	SUITE 304
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-2076
Country	:	US
Telephone Number	:	310-517-1828
Fax Number	:	310-517-0362

Authorized Official
Title or Position	:	OWNER
Name	:	ULYSS CHOW
Credential	:	D.O.
Telephone Number	:	310-517-1828

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/22/2020

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Directions to “PACIFIC BAY MEDICAL GROUP ” Practice Location

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