Provider Demographics
NPI:1750524997
Name:P. M. G.
Entity type:Organization
Organization Name:P. M. G.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:B
Authorized Official - Middle Name:ROCK
Authorized Official - Last Name:CHOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-500-9910
Mailing Address - Street 1:PO BOX 761400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90076-1400
Mailing Address - Country:US
Mailing Address - Phone:818-500-9910
Mailing Address - Fax:818-956-3300
Practice Address - Street 1:2007 WILSHIRE BLVD
Practice Address - Street 2:SUITE 714
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3506
Practice Address - Country:US
Practice Address - Phone:818-500-9910
Practice Address - Fax:818-956-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 89172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty