Provider Demographics
NPI:1518917913
Name:EMERGENCY SPECIALIST PHYSICIANS MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:EMERGENCY SPECIALIST PHYSICIANS MEDICAL ASSOCIATES, INC
Other - Org Name:ESPMA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHOJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-251-3225
Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-751-4664
Mailing Address - Fax:405-749-4561
Practice Address - Street 1:4101 TORRANCE BLVD
Practice Address - Street 2:ER DEPT
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4607
Practice Address - Country:US
Practice Address - Phone:310-303-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0078790Medicaid
CAHW14033Medicare PIN