Provider Demographics
NPI:1487150942
Name:SP MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:SP MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHI-YUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-822-2312
Mailing Address - Street 1:3130 W OLYMPIC BLVD STE 290
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2484
Mailing Address - Country:US
Mailing Address - Phone:213-822-2312
Mailing Address - Fax:
Practice Address - Street 1:3130 W OLYMPIC BLVD STE 290
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2484
Practice Address - Country:US
Practice Address - Phone:213-822-2312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14175171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty