Organization
CROWN CITY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN B. TYSON M.D. (MEDICAL DIRECTOR)
(626) 798-8792
Entity
Organization
Contact information
Practice address
1542 E FLORENCE AVE, LOS ANGELES, CA 90001-2536
(323) 584-0222
(626) 296-1403
Mailing address
1542 E FLORENCE AVE, LOS ANGELES, CA 90001-2536
(323) 584-0222
(626) 296-1403
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0041813
MEDI-CAL PROVIDER #
CA
Enumeration date
04/06/2007
Last updated
07/28/2014
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