Provider Demographics
NPI:1811754690
Name:S&S MEDICAL GROUP
Entity type:Organization
Organization Name:S&S MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDRAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-728-0494
Mailing Address - Street 1:1902 FULLERTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3112
Mailing Address - Country:US
Mailing Address - Phone:951-479-8994
Mailing Address - Fax:619-209-7888
Practice Address - Street 1:1030 S MOUNT VERNON AVE # 200
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4205
Practice Address - Country:US
Practice Address - Phone:951-479-8994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No291U00000XLaboratoriesClinical Medical Laboratory