South Atlantic Medical Group Ipa

LBN: South Atlantic Medical Group Ipa
South Atlantic Medical Group Ipa is an health care organization with primary practice located at 5504 Whittier Blvd , Los Angeles CA 90022-4104. The organization recently has only one registered license in Managed Care Organizations / Exclusive Provider Organization, which is considered as the primary health care specialty. South Atlantic Medical Group Ipa can be contacted via phone (323) 725-0167, or through Kahen, Nissan via phone (323) 725-0167.

Contact Information

Primary practice address
5504 Whittier Blvd Los Angeles CA 90022-4104
Phone: (323) 725-0167
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Kahen, Nissan Doctor of Medicine (MD)
Phone: (323) 725-0167

Health care specialties

SpecialtyCodeLicense #State
Managed Care Organizations / Exclusive Provider Organization 302F00000X A410610 California

Profile Details

NPI number 1114193182
LBN Legal business name South Atlantic Medical Group Ipa
DBA Doing business as
Authorized official Kahen, Nissan Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Apr 30th, 2008
Last updated Apr 30th, 2008 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114193182 NPPES
California MEDICAID 00A410610

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