# CRESCENT PHYSICIAN GROUP

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

## Provider details

- **NPI number:** 1952014698
- **Authorized official:** DR. MICHAEL YADEGARI MD (CEO)
- **Authorized official phone:** (310) 409-6559

## Contact information

- **Practice address:** 2784 CASIANO RD, LOS ANGELES, CA 90077-1524
- **Practice address phone:** (310) 409-6559
- **Practice address fax:** (213) 745-0152
- **Mailing address:** 601 N CRESCENT DR, BEVERLY HILLS, CA 90210-3329
- **Mailing address phone:** (310) 409-6559
- **Mailing address fax:** (213) 745-0152

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QE0800X | Endoscopy Clinic/Center | — | — | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 12/27/2022
- **Last updated:** 12/27/2022