Provider Demographics
NPI:1497824189
Name:GARDENA EMERGENCY MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:GARDENA EMERGENCY MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-538-6629
Mailing Address - Street 1:PO BOX 11260
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-1260
Mailing Address - Country:US
Mailing Address - Phone:562-809-3542
Mailing Address - Fax:
Practice Address - Street 1:1145 WEST REDONDO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3528
Practice Address - Country:US
Practice Address - Phone:310-538-6629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0095870Medicaid
CAHW17964Medicare ID - Type Unspecified