Provider Demographics
NPI:1023595170
Name:PREMIER POINT MEDICAL GROUP
Entity type:Organization
Organization Name:PREMIER POINT MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BADRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DO, MPH
Authorized Official - Phone:310-497-1024
Mailing Address - Street 1:11819 WILSHIRE BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6631
Mailing Address - Country:US
Mailing Address - Phone:714-507-8600
Mailing Address - Fax:310-478-5850
Practice Address - Street 1:11819 WILSHIRE BLVD STE 208
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6631
Practice Address - Country:US
Practice Address - Phone:714-507-8600
Practice Address - Fax:310-478-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-22
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty