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Organization
CROWN CITY MEDICAL GROUP, INC.
Active
Organization
CROWN CITY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN B. TYSON M.D. (MEDICAL DIRECTOR)
(626) 798-8792
Entity
Organization
Contact information
Practice address
1542 E FLORENCE AVE, LOS ANGELES, CA 90001-2536
(323) 584-0222
(626) 296-1403
Mailing address
1542 E FLORENCE AVE, LOS ANGELES, CA 90001-2536
(323) 584-0222
(626) 296-1403
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0041813
MEDI-CAL PROVIDER #
CA
Enumeration date
04/06/2007
Last updated
07/28/2014
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