Provider Demographics
NPI:1700150802
Name:GREEN CROSS MEDICAL SURGICAL INC
Entity Type:Organization
Organization Name:GREEN CROSS MEDICAL SURGICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-288-8671
Mailing Address - Street 1:9310 E. VALLEY BLVD SUITE A
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1924
Mailing Address - Country:US
Mailing Address - Phone:626-288-8671
Mailing Address - Fax:626-288-6648
Practice Address - Street 1:9310 E. VALLEY BLVD SUITE A
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1924
Practice Address - Country:US
Practice Address - Phone:626-288-8671
Practice Address - Fax:626-288-6648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A3502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG24918Medicare UPIN