Fuller, Clark Beeman
Fuller, Clark Beeman is an individual health care provider with primary practice located at 8635 W 3Rd St Suite 975W, Los Angeles CA 90048-6101. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery), Other Service Providers / Specialist. Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) is his primary health care specialty. Fuller, Clark Beeman can be contacted via phone (310) 652-0530.Contact Information
Primary practice address
8635 W 3Rd St Suite 975W
Los Angeles CA 90048-6101
Phone: (310) 652-0530
Fax: (310) 652-9936
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | G76647 | California |
| Other Service Providers / Specialist | 174400000X | G76647 | California |
Profile Details
| NPI number | 1790890341 |
|---|---|
| LBN Legal business name | Fuller, Clark Beeman |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 21st, 2006 |
| Last updated | Apr 19th, 2018 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790890341 | NPPES |
| California | MEDICAID | GR0091070 |
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