Provider Demographics
NPI:1437194917
Name:SOUTHERN CALIFORNIA ENDOCRINE CENTER INCOPORATED
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA ENDOCRINE CENTER INCOPORATED
Other - Org Name:SOUTHERN CALIFORNIA ENDOCRINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-585-8911
Mailing Address - Street 1:207 S SANTA ANITA ST
Mailing Address - Street 2:STE. P-20
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1146
Mailing Address - Country:US
Mailing Address - Phone:626-585-8911
Mailing Address - Fax:626-585-8914
Practice Address - Street 1:207 S SANTA ANITA ST
Practice Address - Street 2:STE. P-20
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1146
Practice Address - Country:US
Practice Address - Phone:626-585-8911
Practice Address - Fax:626-585-8914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60921207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W15365AMedicare ID - Type Unspecified
W15365Medicare ID - Type Unspecified
G73951Medicare UPIN