Southbay Advance Medical Group, Inc.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A27935 Issued in CA

Legal business name

SOUTHBAY ADVANCE MEDICAL GROUP, INC.

Practice address

15731 S Western Ave
Gardena, CA 90247-6157

Phone

(310) 808-0199

NPI assigned

Jul 23, 2006

Organization subpart

No

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

Authorized official

Name

Morris Halfon, MD

Title

Director

Phone

(310) 808-0199

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457373383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15731 S WESTERN AVE",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902476157",
            "telephone_number": "310-808-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15731 S WESTERN AVE",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902476157",
            "telephone_number": "310-808-0199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHBAY ADVANCE MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HALFON",
        "authorized_official_first_name": "MORRIS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "310-808-0199",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A27935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Aug 22, 2020; 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.