Provider Demographics
NPI:1366575169
Name:HOM MEDICAL GROUP INC
Entity type:Organization
Organization Name:HOM MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:HOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-507-0909
Mailing Address - Street 1:PO BOX 881835
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92168-1835
Mailing Address - Country:US
Mailing Address - Phone:858-456-0008
Mailing Address - Fax:858-456-2103
Practice Address - Street 1:737 PEARL ST
Practice Address - Street 2:SUITE 103
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0056
Practice Address - Country:US
Practice Address - Phone:858-456-0008
Practice Address - Fax:858-456-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68160208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA68160BMedicare PIN
CAX98576Medicare UPIN
CAHW16701Medicare PIN