Provider Demographics
NPI:1770649097
Name:ARDMORE MEDICAL GROUP
Entity Type:Organization
Organization Name:ARDMORE MEDICAL GROUP
Other - Org Name:CLINICA HUMANITARIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-562-6170
Mailing Address - Street 1:5953 ATLANTIC BLVD.
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270
Mailing Address - Country:US
Mailing Address - Phone:323-562-6170
Mailing Address - Fax:323-562-6176
Practice Address - Street 1:3500 E WHITTIER BLVD #105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023
Practice Address - Country:US
Practice Address - Phone:323-262-8100
Practice Address - Fax:323-262-2146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty