Provider Demographics
NPI:1699229484
Name:LONG BEACH CORNER CLINIC INC
Entity Type:Organization
Organization Name:LONG BEACH CORNER CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-673-0508
Mailing Address - Street 1:5952 COLDBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1024
Mailing Address - Country:US
Mailing Address - Phone:714-309-4688
Mailing Address - Fax:
Practice Address - Street 1:1936 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3908
Practice Address - Country:US
Practice Address - Phone:714-309-4688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty