Provider Demographics
NPI:1134364243
Name:US MEDICAL GROUP
Entity type:Organization
Organization Name:US MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DSHAIKH
Authorized Official - Middle Name:
Authorized Official - Last Name:IZUCHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:ED
Authorized Official - Phone:310-999-9826
Mailing Address - Street 1:P.O. BOX 84480
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073
Mailing Address - Country:US
Mailing Address - Phone:310-999-9826
Mailing Address - Fax:310-909-8696
Practice Address - Street 1:8610 S. SELPULVEDA BLVD.
Practice Address - Street 2:#208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045
Practice Address - Country:US
Practice Address - Phone:310-999-9826
Practice Address - Fax:310-909-8692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80750207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty