Lakewood Internal Medical Group

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

A22752 Issued in CA

Legal business name

LAKEWOOD INTERNAL MEDICAL GROUP

Practice address

3650 South St
Suite 110
Lakewood, CA 90712-1502

Phone

(562) 633-4117

Fax

(562) 633-6560

NPI assigned

Apr 2, 2007

Last updated

Aug 22, 2020By 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

Dr. Lawrence Gershon, M.D.

Title

President

Phone

(562) 633-4117

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770604407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 SOUTH ST",
            "address_2": "SUITE 110",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907121502",
            "telephone_number": "562-633-4117",
            "fax_number": "562-633-6560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 SOUTH ST",
            "address_2": "SUITE 110",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907121502",
            "telephone_number": "562-633-4117",
            "fax_number": "562-633-6560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD INTERNAL MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GERSHON",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-633-4117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A22752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ70783Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Lakewood, CA
• Providers in Lakewood, CA by specialty
• Primary Care Clinic/Center 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.