Provider Demographics
NPI:1952301947
Name:SOUTHLAND HEMATOLOGY ONCOLOGY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:SOUTHLAND HEMATOLOGY ONCOLOGY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:YU-CHIH
Authorized Official - Last Name:TSAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-652-3333
Mailing Address - Street 1:201 LAURSEN ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4417
Mailing Address - Country:US
Mailing Address - Phone:951-652-3333
Mailing Address - Fax:951-652-8892
Practice Address - Street 1:201 LAURSEN ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4417
Practice Address - Country:US
Practice Address - Phone:951-652-3333
Practice Address - Fax:951-652-8892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-30
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70963207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A709630Medicaid
CA00A709630Medicaid
CA6240680001Medicare NSC
CAZZZ29329ZMedicare ID - Type UnspecifiedMEDICARE GROUP ID