Knee Shoulder Back Orthopedic Medical Group, a Professional Corporatio

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

KNEE SHOULDER BACK ORTHOPEDIC MEDICAL GROUP, A PROFESSIONAL CORPORATIO

Practice address

5417 Pacific Blvd Ste B
Huntington Park, CA 90255-2532

Phone

(323) 581-0101

NPI assigned

Mar 13, 2023

Last updated

Mar 13, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mahfouz Michael, MD

Title

Owner

Phone

(323) 999-8267

Specialties & licenses 6

Addresses

Locations

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

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678665600000",
    "number": "1245931617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 291040",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900299040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5417 PACIFIC BLVD STE B",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902552532",
            "telephone_number": "323-581-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNEE SHOULDER BACK ORTHOPEDIC MEDICAL GROUP, A PROFESSIONAL CORPORATIO",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A",
        "authorized_official_last_name": "MICHAEL",
        "authorized_official_first_name": "MAHFOUZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-999-8267",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "111NX0800X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Orthopedic",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Kim
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• Orthopaedic Surgery Physician in Huntington Park, CA
• Providers in Huntington Park, CA by specialty
• Orthopaedic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; 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.