| South Atlantic Medical Group | |
|
2616 Clarendon Ave Huntington Park CA 90255-4120 | |
| (323) 589-6633 | |
| Not Available |
| Full Name | South Atlantic Medical Group |
|---|---|
| Speciality | General Practice |
| Location | 2616 Clarendon Ave, Huntington Park, California |
| Authorized Official Name and Position | Nissan Kahen (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3237250167 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Atlantic Medical Group 5504 Whittier Blvd Los Angeles CA 90022-4104 Ph: (323) 725-0167 | South Atlantic Medical Group 2616 Clarendon Ave Huntington Park CA 90255-4120 Ph: (323) 589-6633 |
| NPI Number | 1629251541 |
|---|---|
| Provider Enumeration Date | 12/13/2007 |
| Last Update Date | 12/13/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629251541 | NPI | - | NPPES |
| GR0020632 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | A41061 (California) | Primary |
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