Premiere Spine and Sports Medicine

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

PREMIERE SPINE AND SPORTS MEDICINE

Practice address

2255 E Maple Ave
El Segundo, CA 90245-6508

Phone

(310) 322-8777

Fax

(310) 322-8787

NPI assigned

Oct 3, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Dong Hyun Gwag, DC

Title

Owner/Chiropractor

Phone

(714) 334-6211

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1727913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727913600000",
    "number": "1205655644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2255 E MAPLE AVE",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902456508",
            "telephone_number": "310-322-8777",
            "fax_number": "310-322-8787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 E MAPLE AVE",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902456508",
            "telephone_number": "310-322-8777",
            "fax_number": "310-322-8787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIERE SPINE AND SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-03",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A",
        "authorized_official_last_name": "GWAG",
        "authorized_official_first_name": "DONG HYUN",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "714-334-6211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adauzea Prabhakar
• Israel Eugene Prado Jr.
• Magdalena Prado
• Catrina Prather
• Jessica Preciado
• Premiere Sports Medicine Medical Group
• Premise Health of California Medical PC
• Angelique Prescott
• Jack Preston
• Louis Preston

• Chiropractor in El Segundo, CA
• Providers in El Segundo, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; 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.