# SOUTH ATLANTIC MEDICAL GROUP

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

## Provider details

- **NPI number:** 1801079728
- **Authorized official:** NISSAN KAHEN M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (323) 725-0167

## Contact information

- **Practice address:** 11518 GARVEY AVE, EL MONTE, CA 91732-3306
- **Practice address phone:** (626) 575-4584
- **Mailing address:** 5504 WHITTIER BLVD, LOS ANGELES, CA 90022-4104
- **Mailing address phone:** (323) 725-0167

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A41061 | CA | Yes |

## Other

- **Enumeration date:** 12/13/2007
- **Last updated:** 12/13/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0020631 | — | CA |