Provider Demographics
NPI:1609893619
Name:SOUTH BAY GASTROENTEROLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:SOUTH BAY GASTROENTEROLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-539-2055
Mailing Address - Street 1:23456 HAWTHORNE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4716
Mailing Address - Country:US
Mailing Address - Phone:310-539-2055
Mailing Address - Fax:310-539-0199
Practice Address - Street 1:23456 HAWTHORNE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4716
Practice Address - Country:US
Practice Address - Phone:310-539-2055
Practice Address - Fax:310-539-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW2070Medicare ID - Type UnspecifiedMEDICARE PROVIDER #