Provider Demographics
NPI:1952014698
Name:CRESCENT PHYSICIAN GROUP
Entity Type:Organization
Organization Name:CRESCENT PHYSICIAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YADEGARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-409-6559
Mailing Address - Street 1:601 N CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3329
Mailing Address - Country:US
Mailing Address - Phone:310-409-6559
Mailing Address - Fax:213-745-0152
Practice Address - Street 1:2784 CASIANO RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90077-1524
Practice Address - Country:US
Practice Address - Phone:310-409-6559
Practice Address - Fax:213-745-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy