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
1040 ELM AVE, SUITE 100, LONG BEACH, CA 90813-3264
(562) 591-4444
(562) 436-7350
Mailing address
1040 ELM AVE, SUITE 100, LONG BEACH, CA 90813-3264
(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
—
GR0066740
—
CA
01
—
GR0066741
MEDI-CAL GROUP NUMBER
CA
01
—
W13148A
PTAN
—
01
—
W13148B
OTHER PTAN
—
01
—
ZZZ53510Z
BLUE SHIELD PIN#
CA
Enumeration date
11/14/2006
Last updated
05/16/2012
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