Provider Demographics
NPI:1801073978
Name:ORTHOPEDIC CENTER FOR EXCELLENCE MEDICAL GROUP
Entity type:Organization
Organization Name:ORTHOPEDIC CENTER FOR EXCELLENCE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SADAO
Authorized Official - Last Name:HAMADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-540-3145
Mailing Address - Street 1:21350 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 274
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5605
Mailing Address - Country:US
Mailing Address - Phone:310-540-3145
Mailing Address - Fax:310-540-2306
Practice Address - Street 1:21530 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2608
Practice Address - Country:US
Practice Address - Phone:310-540-3145
Practice Address - Fax:310-540-2306
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC CENTER FOR EXCELLENCE MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207X00000X207X00000X
CA207XS011X207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689851693OtherNPI
CAW14084AOtherMEDICARE GROUP PROVIDER N
CA00C304700Medicaid
CAW14084OtherMEDICARE GROUP PROVIDER N
CAWC30470GMedicare PIN
CA1689851693OtherNPI
CAA34275Medicare UPIN