Provider Demographics
NPI:1740227545
Name:TOLWIN PSYCHIATRIC MEDICAL GROUP INC
Entity Type:Organization
Organization Name:TOLWIN PSYCHIATRIC MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-280-9670
Mailing Address - Street 1:PO BOX 34841
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-0841
Mailing Address - Country:US
Mailing Address - Phone:310-280-9670
Mailing Address - Fax:310-280-9675
Practice Address - Street 1:5000 OVERLAND AVE STE 108
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4969
Practice Address - Country:US
Practice Address - Phone:310-280-9670
Practice Address - Fax:310-280-9675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP143802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGPS000990Medicaid
CAGPS000990Medicaid