Provider Demographics
NPI:1487858932
Name:SIMI OBSTETRICS & GYNECOLOGY MEDICAL GROUP A MEDICAL CORP.
Entity Type:Organization
Organization Name:SIMI OBSTETRICS & GYNECOLOGY MEDICAL GROUP A MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-527-8055
Mailing Address - Street 1:1147 RED TAIL WAY
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7232
Mailing Address - Country:US
Mailing Address - Phone:805-527-8055
Mailing Address - Fax:805-520-8849
Practice Address - Street 1:1147 RED TAIL WAY
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-7232
Practice Address - Country:US
Practice Address - Phone:805-527-8055
Practice Address - Fax:805-520-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87602Medicare UPIN
CAI10736Medicare UPIN
CAW15350Medicare PIN
CAG71215Medicare UPIN
CAA36647Medicare UPIN