Organization
SOUTH ATLANTIC MEDICAL GROUP
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
2616 CLARENDON AVE, HUNTINGTON PARK, CA 90255-4120
(323) 589-6633
Mailing address
5504 WHITTIER BLVD, LOS ANGELES, CA 90022-4104
(323) 725-0167
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A41061
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0020632
—
CA
Enumeration date
12/13/2007
Last updated
12/13/2007
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