Provider Demographics
NPI:1306205570
Name:BLUE OAK MEDICAL GROUP
Entity Type:Organization
Organization Name:BLUE OAK MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-258-5716
Mailing Address - Street 1:10801 NATIONAL BLVD STE 520
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4149
Mailing Address - Country:US
Mailing Address - Phone:424-258-5716
Mailing Address - Fax:
Practice Address - Street 1:4300 LONG BEACH BLVD STE 170
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807
Practice Address - Country:US
Practice Address - Phone:562-216-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine