Provider Demographics
NPI:1821325523
Name:ISABEL MEDICAL GROUP,INC
Entity Type:Organization
Organization Name:ISABEL MEDICAL GROUP,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:BUI
Authorized Official - Last Name:HAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-231-0106
Mailing Address - Street 1:4407 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-2731
Mailing Address - Country:US
Mailing Address - Phone:323-231-0106
Mailing Address - Fax:323-231-6351
Practice Address - Street 1:4407 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2731
Practice Address - Country:US
Practice Address - Phone:323-231-0106
Practice Address - Fax:323-231-6351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty