| Apex Multispecialty Medical Group, Inc | |
|
600 S San Vicente Blvd Ste 101 Los Angeles CA 90048-4664 | |
| (310) 873-3312 | |
| (424) 270-1313 |
| Full Name | Apex Multispecialty Medical Group, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 600 S San Vicente Blvd Ste 101, Los Angeles, California |
| Authorized Official Name and Position | Daniel Ling (CFO) |
| Authorized Official Contact | 3107867204 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Apex Multispecialty Medical Group, Inc 9663 Santa Monica Blvd Ste 883 Beverly Hills CA 90210-4303 Ph: () - | Apex Multispecialty Medical Group, Inc 600 S San Vicente Blvd Ste 101 Los Angeles CA 90048-4664 Ph: (310) 873-3312 |
| NPI Number | 1023672367 |
|---|---|
| Provider Enumeration Date | 04/23/2019 |
| Last Update Date | 06/28/2023 |
| Medicare PECOS PAC ID | 3375978497 |
|---|---|
| Medicare Enrollment ID | O20200120000780 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023672367 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Henry A Horton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457653602 PECOS PAC ID: 5395904320 Enrollment ID: I20120312000563 |
| Provider Name | Nattapaun N Thepyasuwan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396050746 PECOS PAC ID: 0345499612 Enrollment ID: I20121001000402 |
| Provider Name | Gelsey L Goodstein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790097442 PECOS PAC ID: 7012156474 Enrollment ID: I20130614000176 |
| Provider Name | Daniel E Ling |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285964577 PECOS PAC ID: 0042430209 Enrollment ID: I20141010000607 |
| Provider Name | Kimanh D Nguyen |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1730359258 PECOS PAC ID: 1658685870 Enrollment ID: I20150731017027 |
| Provider Name | Franklin E Bolanos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215219712 PECOS PAC ID: 8426324161 Enrollment ID: I20171024001722 |
| Provider Name | Jonathan Slade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841705233 PECOS PAC ID: 3779843917 Enrollment ID: I20180207001466 |
| Provider Name | Gerardo Canedo |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1588068969 PECOS PAC ID: 3072875350 Enrollment ID: I20190731002342 |
| Provider Name | Erin Bombane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306493101 PECOS PAC ID: 9032541545 Enrollment ID: I20191120003029 |
| Provider Name | Girish Mohan |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1093193161 PECOS PAC ID: 0446547277 Enrollment ID: I20201125000052 |
| Provider Name | Kelsey Mcneill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518543990 PECOS PAC ID: 2961819099 Enrollment ID: I20210407001978 |
| Provider Name | Joanna K Stuppler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629666268 PECOS PAC ID: 9335549542 Enrollment ID: I20210609002761 |
| Provider Name | Ambika Bhushan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992169825 PECOS PAC ID: 1355629502 Enrollment ID: I20211026003188 |
| Provider Name | Jessica Sivakumar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699427724 PECOS PAC ID: 1052708088 Enrollment ID: I20220421002300 |
| Provider Name | Azita A Gholami |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245953686 PECOS PAC ID: 4587036751 Enrollment ID: I20230216001014 |
| Provider Name | Phison Huu Pham |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891258422 PECOS PAC ID: 7012377609 Enrollment ID: I20230713003853 |
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