Provider Demographics
NPI:1821375965
Name:SOUTHBAY FAMILY MEDICAL CLINIC
Entity Type:Organization
Organization Name:SOUTHBAY FAMILY MEDICAL CLINIC
Other - Org Name:SOUTHBAY FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHRIKANT
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMHANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-834-5388
Mailing Address - Street 1:23517 S MAIN ST.
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23517 MAIN ST
Practice Address - Street 2:SUITE # 103
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-5251
Practice Address - Country:US
Practice Address - Phone:310-834-5388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19910282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital