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Organization

GREEN, STUART & MARINOW, HARRY & BONFILIO, NICHOLAS & FEIWELL, LAWRENC

Active
Other names
GREATER LONG BEACH ORTHOPAEDIC SURGICAL & MEDICAL GROUP A PTRSHP
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DUKE AHN M.D. (MANAGING PARTNER)
(562) 430-3561
Entity
Organization

Contact information

Practice address
3771 KATELLA AVE, SUITE 310, LOS ALAMITOS, CA 90720-3115
(562) 430-3561
(562) 431-8882
Mailing address
1040 ELM AVE, SUITE 100, LONG BEACH, CA 90813-3265
(562) 591-4444
(562) 436-7350

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GR0066741
CA
01
W13148A
OTHER PTAN
01
W13148B
PTAN
01
ZZZ53512Z
BLUE SHIELD PIN NUMBER
CA
Enumeration date
07/31/2007
Last updated
02/01/2013
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