Provider Demographics
NPI:1063560902
Name:CALIFORNIA PULMONARY DISEASE MEDICAL GROUP INC
Entity type:Organization
Organization Name:CALIFORNIA PULMONARY DISEASE MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FOUAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEN-ISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-821-1187
Mailing Address - Street 1:1200 SHADOW HILL WAY
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-821-1187
Mailing Address - Fax:310-276-7289
Practice Address - Street 1:1200 SHADOW HILL WAY
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-821-1187
Practice Address - Fax:310-276-7289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A252520Medicaid
A24346Medicare UPIN
CAW3437Medicare ID - Type Unspecified