Organization
EXECUTIVE INTERGRATED MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAMAL BIJANPOUR MD (PRESIDENT / CEO)
(310) 559-5916
Entity
Organization
Contact information
Practice address
3605 LONG BEACH BLVD STE 304, LONG BEACH, CA 90807-6018
(310) 559-5916
(310) 559-5466
Mailing address
3605 LONG BEACH BLVD STE 304, LONG BEACH, CA 90807-6018
(310) 559-5916
(310) 559-5466
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
2084P0802X
Addiction Psychiatry Physician
Primary
A109162
CA
2084P0805X
Geriatric Psychiatry Physician
A109162
CA
Other
Enumeration date
05/16/2017
Last updated
07/21/2022
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