Provider Demographics
NPI:1093854812
Name:GYNECOLOGY & OBSTETRICS MEDICAL GRP INC FKA
Entity Type:Organization
Organization Name:GYNECOLOGY & OBSTETRICS MEDICAL GRP INC FKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-595-5331
Mailing Address - Street 1:3550 LINDEN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4577
Mailing Address - Country:US
Mailing Address - Phone:562-595-5331
Mailing Address - Fax:562-595-1335
Practice Address - Street 1:3550 LINDEN AVE STE 1
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4577
Practice Address - Country:US
Practice Address - Phone:562-595-5331
Practice Address - Fax:562-595-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36885207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84920Medicare UPIN
CAW14506Medicare ID - Type Unspecified