Pacific Shores Radiology Medical Group Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

G60583 Issued in CA

Legal business name

PACIFIC SHORES RADIOLOGY MEDICAL GROUP INC.

Practice address

1025 S Anaheim Blvd
Anaheim, CA 92805-5806

Phone

(714) 563-2813

Fax

(714) 502-2691

NPI assigned

Dec 29, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Michael Poh, M.D.

Title

President

Phone

(310) 792-3914

Specialties & licenses 1

Addresses

Other identifiers 1

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477958400000",
    "number": "1326104605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3129",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905103129",
            "telephone_number": "310-792-3914",
            "fax_number": "855-898-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 S ANAHEIM BLVD",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928055806",
            "telephone_number": "714-563-2813",
            "fax_number": "714-502-2691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC SHORES RADIOLOGY MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2016-11-01",
        "status": "A",
        "authorized_official_last_name": "POH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-792-3914",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G60583",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326104605",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pacific Gis Dba Sultan Adult Day Health Care Center
• Pacific Hand & Orthopedic Surgery Center Inc
• Pacific in Home Care LLC Dba Acti-Kare Responsive in-Home Care
• Pacific Mobile Wound Care
• Pacific Nephrology Associates Medical Group, PC
• Pacific Vein and Wound
• Pacific Wavecrest Medical Corporation
• Pacific Wellness & Family Therapy Corp
• Pacifica SL Anaheim Hills LLC
• Cesar David Padilla

• Specialist in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2016; 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.