Provider Demographics
NPI:1003917048
Name:CHILDREN'S MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CHILDREN'S MEDICAL GROUP, INC.
Other - Org Name:GWEN KLYMAN-FRIEND M.D., INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERGIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-539-2445
Mailing Address - Street 1:3440 LOMITA BLVD STE 352
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4821
Mailing Address - Country:US
Mailing Address - Phone:310-539-2445
Mailing Address - Fax:310-539-0061
Practice Address - Street 1:3440 W. LOMITA BLVD.
Practice Address - Street 2:SUITE 352
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4858
Practice Address - Country:US
Practice Address - Phone:310-539-2445
Practice Address - Fax:310-539-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13850208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty