Provider Demographics
NPI:1851913917
Name:SAINT BISHOY MEDICAL GROUP
Entity Type:Organization
Organization Name:SAINT BISHOY MEDICAL GROUP
Other - Org Name:ST. BISHOY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:BISHOY
Authorized Official - Middle Name:G
Authorized Official - Last Name:KAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-710-9102
Mailing Address - Street 1:8545 SATURN ST APT 103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3658
Mailing Address - Country:US
Mailing Address - Phone:424-777-0025
Mailing Address - Fax:
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 3900
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2436
Practice Address - Country:US
Practice Address - Phone:424-777-0025
Practice Address - Fax:424-777-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFK7828239OtherDEA