Provider Demographics
NPI:1164817847
Name:WEST COAST PHYSICIANS GROUP, INC
Entity Type:Organization
Organization Name:WEST COAST PHYSICIANS GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-888-1415
Mailing Address - Street 1:3900 KILROY AIRPORT WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-6809
Mailing Address - Country:US
Mailing Address - Phone:562-888-1415
Mailing Address - Fax:562-424-1826
Practice Address - Street 1:3900 KILROY AIRPORT WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-6809
Practice Address - Country:US
Practice Address - Phone:562-888-1415
Practice Address - Fax:562-424-1826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization