South Atlantic Medical Group

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A41061 Issued in CA

Legal business name

SOUTH ATLANTIC MEDICAL GROUP

Practice address

1030 W Gardena Blvd
Gardena, CA 90247-4956

Phone

(310) 323-9999

NPI assigned

Dec 7, 2007

Organization subpart

No

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

Authorized official

Name

Nissan Kahen, M.D.

Title

Medical Director

Phone

(323) 725-0167

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1196985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197504000000",
    "number": "1306029806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5504 WHITTIER BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900224104",
            "telephone_number": "323-725-0167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 W GARDENA BLVD",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902474956",
            "telephone_number": "310-323-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH ATLANTIC MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-07",
        "last_updated": "2007-12-13",
        "status": "A",
        "authorized_official_last_name": "KAHEN",
        "authorized_official_first_name": "NISSAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "323-725-0167",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A41061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0020634",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joscelyn Soto
• Licci Soto
• Lynn Soto
• Monica Cecilia Soto
• Chantal Sotomayor, OTR
• South Bay Companies Group, Inc.
• South Bay Family Healthcare Center
• South Bay Senior Health, Inc.
• Southbay Advance Medical Group, Inc.
• Emily Parrish Southwell, DPT

• General Practice Physician in Gardena, CA
• Providers in Gardena, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2007; 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.