NPIMap

Organization Active NPI

Executive Intergrated Medical Group, Inc.

  • Addiction Psychiatry Physician
  • Long Beach, CA
National Provider Identifier
1326575812
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Psychiatry PhysicianTaxonomy code 2084P0802X
License
A109162 Issued in CA
Legal business name
EXECUTIVE INTERGRATED MEDICAL GROUP, INC.
Practice address
3605 Long Beach Blvd Ste 304
Long Beach, CA 90807-6018
Phone
(310) 559-5916
Fax
(310) 559-5466
NPI assigned
May 16, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Kamal Bijanpour, MDNPI 1598903858
Title
President / Ceo
Phone
(310) 559-5916

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X
Addiction Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0802X A109162 CA Primary
Geriatric Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0805X A109162 CA

Addresses

Primary practice location

3605 Long Beach Blvd Ste 304
Long Beach, CA 90807-6018

Mailing address

3605 Long Beach Blvd Ste 304
Long Beach, CA 90807-6018
Phone (310) 559-5916

National Provider Directory

National Provider Directory

Locations

3605 Long Beach Blvd
Ste 304
Long Beach, CA 90807
Phone (310) 559-5916

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": "1494892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1326575812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3605 LONG BEACH BLVD STE 304",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908076018",
            "telephone_number": "310-559-5916",
            "fax_number": "310-559-5466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3605 LONG BEACH BLVD STE 304",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908076018",
            "telephone_number": "310-559-5916",
            "fax_number": "310-559-5466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE INTERGRATED MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-16",
        "last_updated": "2022-07-21",
        "certification_date": "2021-05-21",
        "status": "A",
        "authorized_official_last_name": "BIJANPOUR",
        "authorized_official_first_name": "KAMAL",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "310-559-5916",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "CA",
            "license": "A109162",
            "primary": true
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "CA",
            "license": "A109162",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.