Provider Demographics
NPI:1235336181
Name:COAST HEMATOLOGY-ONCOLOGY ASSOC. MED. GROUP INC.
Entity Type:Organization
Organization Name:COAST HEMATOLOGY-ONCOLOGY ASSOC. MED. GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EKNATH
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-997-4070
Mailing Address - Street 1:701 EAST 28TH STREET
Mailing Address - Street 2:#418
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2661
Mailing Address - Country:US
Mailing Address - Phone:562-997-4070
Mailing Address - Fax:562-997-4090
Practice Address - Street 1:701 EAST 28TH STREET
Practice Address - Street 2:#418 SUITE 260
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2657
Practice Address - Country:US
Practice Address - Phone:562-997-4070
Practice Address - Fax:562-997-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26505174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0048530Medicaid
CAGR0048530Medicaid