South Atlantic Medical Group, Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A41061 Issued in CA

Legal business name

SOUTH ATLANTIC MEDICAL GROUP, INC

Practice address

5504 Whittier Blvd
Los Angeles, CA 90022-4104

Phone

(323) 725-0167

NPI assigned

Dec 13, 2007

Last updated

Jul 28, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nissan Kahen, M.D.

Title

Medical Director

Phone

(323) 725-0167

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1197504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248739200000",
    "number": "1710160627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5504 WHITTIER BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900224104",
            "telephone_number": "323-725-0167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5504 WHITTIER BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900224104",
            "telephone_number": "323-725-0167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH ATLANTIC MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-13",
        "last_updated": "2009-07-28",
        "status": "A",
        "authorized_official_last_name": "KAHEN",
        "authorized_official_first_name": "NISSAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "323-725-0167",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A41061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0020630",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nagi N. Sous, MD
• Emily Priscilla Sousa, PHD, PPCNP-BC, MPH
• Renato Sousa, DPM
• South Atlantic Medical Group
• South Atlantic Medical Group Ipa
• South Bay Senior Services Inc (Homewatch Caregivers of West LA and South Bay)
• South Bay Senior Services, Inc (Better Living In-Home Care)
• South Baylo University (South Baylo University LA Clinic)
• South Central Family Health Center (SCFHC - Vision Care Center)
• South Central Family Health Center

• General Practice Physician in Los Angeles, CA
• Providers in Los Angeles, 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 Jul 28, 2009; 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.