Provider Demographics
NPI:1821266354
Name:CORDAY MEDICAL GROUP
Entity Type:Organization
Organization Name:CORDAY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CORDAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-855-8081
Mailing Address - Street 1:8639 W. THIRD STREET
Mailing Address - Street 2:790W
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048
Mailing Address - Country:US
Mailing Address - Phone:310-855-8081
Mailing Address - Fax:
Practice Address - Street 1:8639 W. 3RD STREET
Practice Address - Street 2:790W
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-855-8081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORDAY AND CORDAY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ82542ZMedicaid
010034153OtherRAILROAD MEDICARE
CAZZZ53071YOtherBLUE SHIELD OF CALIFORNIA
CAZZZ53071YOtherBLUE SHIELD OF CALIFORNIA