# CLARK BEEMAN FULLER MD INC

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

## Provider details

- **NPI number:** 1538506910
- **Authorized official:** CLARK B FULLER MD (PRESIDENT)
- **Authorized official phone:** (310) 854-0909

## Contact information

- **Practice address:** 8631 W 3RD ST, SUITE 1140E, LOS ANGELES, CA 90048-5901
- **Practice address phone:** (310) 854-0909
- **Practice address fax:** (310) 494-0511
- **Mailing address:** 9663 SANTA MONICA BLVD, SUITE 383, BEVERLY HILLS, CA 90210-4303
- **Mailing address phone:** (310) 854-0909
- **Mailing address fax:** (310) 494-0511

## Taxonomy

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

## Other

- **Enumeration date:** 05/26/2013
- **Last updated:** 05/26/2013