Amg, a Professional Medical Corporation
Organization Active NPI Family Medicine Physician · Maywood, CA
NPI 1417722232 · NPPES record last updated Nov 28, 2023
Key facts
- NPI
- 1417722232
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- AMG, A PROFESSIONAL MEDICAL CORPORATION
- Practice address
- 4528 Slauson Ave
Maywood, CA 90270-2934 - Phone
- (213) 792-4456
- NPI assigned
- Nov 21, 2023
- Organization subpart
- No
Authorized official
- Name
- Thomas S. Lam, MD
- Title
- Chief Executive Officer
- Phone
- (626) 943-6228
Corporate family (same tax ID) 2
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0887287 | Amg, a Professional Medical Corp | Certificate of waiver | Jun 8, 2028 |
| 05D0997831 | Amg, a Professional Medical Corp | Certificate of waiver | Mar 27, 2028 |
| 05D2319997 | Amg a Professional Medical Corp | Certificate of waiver | Mar 10, 2027 |
National Provider Directory
- Tax ID family
- Amg a Professional Medical
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| General Practice Physician |
208D00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
4528 Slauson Ave
Maywood, CA 90270-2934
Mailing address
4528 Slauson Ave
Maywood, CA 90270-2934
Phone (213) 792-4456
Other practice location 1
3500 Whittier Blvd Ste 105
Los Angeles, CA 90023-1746
Phone (213) 792-4456
Other practice location 2
3564 Santa Anita Ave Ste A
El Monte, CA 91731-2458
Phone (213) 792-4456
Other practice location 3
2765 E Florence Ave
Huntington Park, CA 90255-5750
Phone (213) 792-4456
Other practice location 4
3518 W 8th St
Los Angeles, CA 90005-2902
Phone (213) 792-4456
Other providers in Maywood, CA
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- Mayra Alvarez
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- Andmore Medical Group
- Andy Medical, Inc
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All providers in Maywood, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 28, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.