NPIMap

Organization Active NPI

Cancer Care Associates Medical Group Inc

  • Clinical Medical Laboratory
  • Redondo Beach, CA
National Provider Identifier
1104813187
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
CANCER CARE ASSOCIATES MEDICAL GROUP INC
Practice address
514 N Prospect Ave
4TH Floor
Redondo Beach, CA 90277-3040
Phone
(310) 750-3300
Fax
(310) 750-3381
NPI assigned
Oct 4, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
David Chan, MD
Title
Co Owner President
Phone
(310) 750-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X CA Primary

Addresses

Primary practice location

514 N Prospect Ave
4TH Floor
Redondo Beach, CA 90277-3040

Mailing address

514 N Prospect Ave
4TH Floor
Redondo Beach, CA 90277-3040
Phone (310) 750-3300

Other names 1

  • Cancer Care Associates Clinical Laboratory Other name

National Provider Directory

National Provider Directory
Tax ID family
Cancer Care Associates Medical Group Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104813187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 N PROSPECT AVE",
            "address_2": "4TH FLOOR",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773040",
            "telephone_number": "310-750-3300",
            "fax_number": "310-750-3381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 N PROSPECT AVE",
            "address_2": "4TH FLOOR",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773040",
            "telephone_number": "310-750-3300",
            "fax_number": "310-750-3381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANCER CARE ASSOCIATES MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CO OWNER PRESIDENT",
        "authorized_official_telephone_number": "310-750-3300",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cancer Care Associates Clinical Laboratory",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Redondo Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.