Coast City Medical Group Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G26972 Issued in CA

Legal business name

COAST CITY MEDICAL GROUP INC.

Practice address

3736 Atlantic Ave # 3
Long Beach, CA 90807-3409

Phone

(562) 595-6396

Fax

(562) 595-6693

NPI assigned

Feb 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Samuel Chan, M.D.

Title

Owner

Phone

(562) 595-6396

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689719429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3736 ATLANTIC AVE # 3",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908073409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3736 ATLANTIC AVE # 3",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908073409",
            "telephone_number": "562-595-6396",
            "fax_number": "562-595-6693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAST CITY MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "562-595-6396",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G26972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon Lee Clough
• Nick Dane Clough, RN
• Timothy Patrick Clougherty, M.D.
• Courtney Abigail Clyde, PT, DPT
• Jevangeline Co-Vivo
• Coast Hem Oncology
• Coast Hematology-Oncology Assoc. Med. Group Inc.
• Coast Nephrology Medical Group Inc.
• Coast Neurosurgical Associates a Medical Group (Coast Neurosurgical Associates)
• Coast Psychiatric Associates

• Family Medicine Physician in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Family Medicine 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.