# KNEE SHOULDER BACK ORTHOPEDIC MEDICAL GROUP, A PROFESSIONAL CORPORATIO

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

## Provider details

- **NPI number:** 1245931617
- **Authorized official:** MAHFOUZ MICHAEL MD (OWNER)
- **Authorized official phone:** (323) 999-8267

## Contact information

- **Practice address:** 5417 PACIFIC BLVD STE B, HUNTINGTON PARK, CA 90255-2532
- **Practice address phone:** (323) 581-0101
- **Mailing address:** PO BOX 291040, LOS ANGELES, CA 90029-9040

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NX0800X | Orthopedic Chiropractor | — | NULL | — |
| 111NX0800X | Orthopedic Chiropractor | — | — | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |
| 261QP3300X | Pain Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 03/13/2023
- **Last updated:** 03/13/2023