Provider Demographics
NPI:1881633287
Name:CEDARS TOWERS SURGICAL MEDICAL GROUP
Entity Type:Organization
Organization Name:CEDARS TOWERS SURGICAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DUNKELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:310-595-2700
Mailing Address - Street 1:8635 W 3RD ST STE 350W
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6112
Mailing Address - Country:US
Mailing Address - Phone:310-595-2700
Mailing Address - Fax:424-278-1390
Practice Address - Street 1:8635 W 3RD ST STE 350W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6112
Practice Address - Country:US
Practice Address - Phone:310-595-2700
Practice Address - Fax:424-278-1390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10168BOtherMEDICARE PTAN
CAGR0054580Medicaid
CAW10168COtherMEDICARE PTAN
CAW10168EOtherMEDICARE PTAN
CAW10168DOtherMEDICARE PTAN
CAW10168AOtherMEDICARE PTAN
CAW10168FOtherMEDICARE PTAN
CAW10168DOtherMEDICARE PTAN