Provider Demographics
NPI:1639475312
Name:SOUTHERN CALIFORNIA MEDICAL COALITION INC.
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA MEDICAL COALITION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-766-2000
Mailing Address - Street 1:5000 AIRPORT PLAZA DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1275
Mailing Address - Country:US
Mailing Address - Phone:562-766-2000
Mailing Address - Fax:562-766-2008
Practice Address - Street 1:5000 AIRPORT PLAZA DR STE 150
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1275
Practice Address - Country:US
Practice Address - Phone:562-766-2000
Practice Address - Fax:562-766-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization