Provider Demographics
NPI:1407997463
Name:GEORGE H TARRYK JR MD
Entity Type:Organization
Organization Name:GEORGE H TARRYK JR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:TARRYK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:562-989-1322
Mailing Address - Street 1:2491 PACIFIC AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2900
Mailing Address - Country:US
Mailing Address - Phone:562-989-1322
Mailing Address - Fax:562-989-1512
Practice Address - Street 1:2491 PACIFIC AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2900
Practice Address - Country:US
Practice Address - Phone:562-989-1322
Practice Address - Fax:562-989-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G146551Medicaid
CAW18646Medicare ID - Type UnspecifiedPACIFIC STE 3 LOCATION
CA00G146551Medicaid
CAWG14655AMedicare ID - Type UnspecifiedPPIN FOR GROUP