Provider Demographics
NPI:1083638530
Name:CITY OF LONG BEACH
Entity Type:Organization
Organization Name:CITY OF LONG BEACH
Other - Org Name:CITY OF LONG BEACH HEALTH DEPT
Other - Org Type:Other Name
Authorized Official - Title/Position:CITY HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-570-4047
Mailing Address - Street 1:2525 GRAND AVE
Mailing Address - Street 2:ROOM #260
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1765
Mailing Address - Country:US
Mailing Address - Phone:562-570-4075
Mailing Address - Fax:562-570-4070
Practice Address - Street 1:2525 GRAND AVE
Practice Address - Street 2:ROOM #260
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1765
Practice Address - Country:US
Practice Address - Phone:562-570-4075
Practice Address - Fax:562-570-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB88088FMedicare UPIN
05D0688088Medicare ID - Type Unspecified