Provider Demographics
NPI:1902835077
Name:IN, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:IN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S VIRGIL AVE STE 501
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1450
Mailing Address - Country:US
Mailing Address - Phone:323-735-7700
Mailing Address - Fax:213-380-8202
Practice Address - Street 1:500 S VIRGIL AVE STE 501
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1450
Practice Address - Country:US
Practice Address - Phone:323-735-7700
Practice Address - Fax:213-380-8202
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A485650Medicaid
CA00A485650Medicaid