Organization
SOUTH ATLANTIC MEDICAL GROUP IPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NISSAN KAHEN M.D. (MEDICAL DIRECTOR)
(323) 725-0167
Entity
Organization
Contact information
Practice address
5504 WHITTIER BLVD, LOS ANGELES, CA 90022-4104
(323) 725-0167
Mailing address
5504 WHITTIER BLVD, LOS ANGELES, CA 90022-4104
(323) 725-0167
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
A410610
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A410610
—
CA
Enumeration date
04/30/2008
Last updated
04/30/2008
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