Provider Demographics
NPI:1700555364
Name:SPECIALTY CARE PAIN MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SPECIALTY CARE PAIN MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-985-1779
Mailing Address - Street 1:1653 7TH ST UNIT 7548
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90406-8012
Mailing Address - Country:US
Mailing Address - Phone:310-564-6139
Mailing Address - Fax:626-609-4195
Practice Address - Street 1:11500 W OLYMPIC BLVD STE 502
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1528
Practice Address - Country:US
Practice Address - Phone:310-985-1779
Practice Address - Fax:626-609-4195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty