Provider Demographics
NPI:1518606177
Name:CONCIERGE SPECIALIST MEDICAL GROUP INC PC
Entity Type:Organization
Organization Name:CONCIERGE SPECIALIST MEDICAL GROUP INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:310-370-4558
Mailing Address - Street 1:4201 TORRANCE BLVD STE 750
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4520
Mailing Address - Country:US
Mailing Address - Phone:310-370-4558
Mailing Address - Fax:310-540-0733
Practice Address - Street 1:13330 BLOOMFIELD AVE STE 209
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3251
Practice Address - Country:US
Practice Address - Phone:562-513-2595
Practice Address - Fax:877-280-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty