Pacific Medical Group

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

PACIFIC MEDICAL GROUP

Practice address

5450 Lincoln Blvd
Playa Vista, CA 90094-2002

Phone

(310) 305-9200

Fax

(310) 305-2800

NPI assigned

Sep 2, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samson Yirgu

Title

Manager

Phone

(310) 305-9200

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599004800000",
    "number": "1104430669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4712 ADMIRALTY WAY # 574",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926905",
            "telephone_number": "310-305-9200",
            "fax_number": "310-305-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5450 LINCOLN BLVD",
            "city": "PLAYA VISTA",
            "state": "CA",
            "postal_code": "900942002",
            "telephone_number": "310-305-9200",
            "fax_number": "310-305-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-02",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A",
        "authorized_official_last_name": "YIRGU",
        "authorized_official_first_name": "SAMSON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "310-305-9200"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Nowakhtar
• Valerij Oks
• Osayamen O Omoruyi, M.D.
• Jeanine Marie Osler, R.D.
• Ivette Osorio
• Cora Palma, PHD, LEP, PPS
• Prisha Patel, MD
• Playa Medical Management LLC
• Playa Physical Therapy
• Playa Vista Dental

• Surgery Physician in Playa Vista, CA
• Providers in Playa Vista, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.