# LAX MEDICAL GROUP, INC

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

## Provider details

- **NPI number:** 1508501503
- **Authorized official:** SAMSON YIRGU (PRESIDENT)
- **Authorized official phone:** (310) 867-5556

## Contact information

- **Practice address:** 5450 LINCOLN BLVD, PLAYA VISTA, CA 90094-2002
- **Practice address phone:** (310) 867-5556
- **Practice address fax:** (888) 302-0594
- **Mailing address:** 1223 WILSHIRE BLVD \# 884, SANTA MONICA, CA 90403-5406

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/03/2022
- **Last updated:** 05/03/2022