# CHAMPION MEDICAL GROUP, A MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CHAMPION MEDICAL GROUP, A MEDICAL CORPORATION
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1639460066
- **Legal business name:** CHAMPION MEDICAL GROUP, A MEDICAL CORPORATION
- **Authorized official:** HERBERT MARSHAK MD (MEDICAL LIAISON)
- **Authorized official phone:** (310) 474-9809

## Contact information

- **Practice address:** 1902 ROYALTY DR, STE 290, POMONA, CA 91767-3030
- **Practice address phone:** (909) 397-9007
- **Mailing address:** 2980 N BEVERLY GLEN CIR, SUITE 100, LOS ANGELES, CA 90077-1726
- **Mailing address phone:** (310) 474-9809
- **Mailing address fax:** (888) 431-8819

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | Yes |

## Other

- **Enumeration date:** 04/19/2011
- **Last updated:** 10/05/2015