# ADVANCED CARDIOTHORACIC SURGERY MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104818715
- **Authorized official:** ALI GHEISSARI M.D. (PRESIDENT)
- **Authorized official phone:** (213) 483-1055

## Contact information

- **Practice address:** 1245 WILSHIRE BLVD, SUITE 606, LOS ANGELES, CA 90017-4810
- **Practice address phone:** (213) 483-1055
- **Practice address fax:** (213) 483-1418
- **Mailing address:** 1245 WILSHIRE BLVD, SUITE 606, LOS ANGELES, CA 90017-4810
- **Mailing address phone:** (213) 483-1055
- **Mailing address fax:** (213) 483-1418

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | G72926 | CA | Yes |

## Other

- **Enumeration date:** 08/19/2005
- **Last updated:** 09/29/2011