Provider Demographics
NPI:1821294794
Name:SOUTHERN CALIFORNIA CENTER FOR SEXUAL HEALTH AND SURVIVORSHIP MED
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA CENTER FOR SEXUAL HEALTH AND SURVIVORSHIP MED
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:KRYCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-902-5851
Mailing Address - Street 1:PO BOX 2718
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-1318
Mailing Address - Country:US
Mailing Address - Phone:949-764-9300
Mailing Address - Fax:949-764-9399
Practice Address - Street 1:355 PLACENTIA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3311
Practice Address - Country:US
Practice Address - Phone:949-764-9300
Practice Address - Fax:949-764-9399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54134207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22166Medicare PIN