Provider Demographics
NPI:1982635637
Name:ID MED A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ID MED A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:DING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-784-5880
Mailing Address - Street 1:23430 HAWTHORNE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4730
Mailing Address - Country:US
Mailing Address - Phone:310-784-5880
Mailing Address - Fax:310-325-3117
Practice Address - Street 1:23430 HAWTHORNE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4730
Practice Address - Country:US
Practice Address - Phone:310-784-5880
Practice Address - Fax:310-325-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty