NPIMap

Organization Active NPI

Champion Medical Group, a Medical Corporation

  • Non-Pharmacy Dispensing Site
  • Pomona, CA
National Provider Identifier
1639460066
Registry record updated Oct 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
CHAMPION MEDICAL GROUP, A MEDICAL CORPORATION
Practice address
1902 Royalty Dr
Ste 290
Pomona, CA 91767-3030
Phone
(909) 397-9007
NPI assigned
Apr 19, 2011
Last updated
Oct 5, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
CHAMPION MEDICAL GROUP, A MEDICAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 5, 2015

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

Authorized official

Name
Herbert Marshak, MD
Title
Medical Liaison
Phone
(310) 474-9809

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

1902 Royalty Dr
Ste 290
Pomona, CA 91767-3030

Mailing address

2980 N Beverly Glen Cir
Suite 100
Los Angeles, CA 90077-1726
Phone (310) 474-9809

National Provider Directory

National Provider Directory
Tax ID family
Champion Medical Group a Medical Corporation7 organizations share this tax ID, including this one
Part of
Champion Medical Group a Medical Corporation

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1303171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444003200000",
    "number": "1639460066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 N BEVERLY GLEN CIR",
            "address_2": "SUITE 100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900771726",
            "telephone_number": "310-474-9809",
            "fax_number": "888-431-8819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1902 ROYALTY DR",
            "address_2": "STE 290",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673030",
            "telephone_number": "909-397-9007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPION MEDICAL GROUP, A MEDICAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHAMPION MEDICAL GROUP, A MEDICAL CORPORATION",
        "enumeration_date": "2011-04-19",
        "last_updated": "2015-10-05",
        "status": "A",
        "authorized_official_last_name": "MARSHAK",
        "authorized_official_first_name": "HERBERT",
        "authorized_official_title_or_position": "MEDICAL LIAISON",
        "authorized_official_telephone_number": "310-474-9809",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2015; 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.