Provider Demographics
NPI:1770259749
Name:AFTERMATH MEDICAL GROUP, ONC.
Entity Type:Organization
Organization Name:AFTERMATH MEDICAL GROUP, ONC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:N
Authorized Official - Last Name:OPOKU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:323-974-3211
Mailing Address - Street 1:2222 FOOTHILL BLVD # E122
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1456
Mailing Address - Country:US
Mailing Address - Phone:323-974-3211
Mailing Address - Fax:213-389-2506
Practice Address - Street 1:2520 W 8TH ST STE 106
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3861
Practice Address - Country:US
Practice Address - Phone:213-389-2526
Practice Address - Fax:213-389-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty