South Atlantic Medical Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A41061 Issued in CA

Legal business name

SOUTH ATLANTIC MEDICAL GROUP

Practice address

5504 Whittier Blvd
Los Angeles, CA 90022-4104

Phone

(323) 725-0167

Fax

(323) 725-6933

NPI assigned

Jul 20, 2006

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

Tax ID family

South Atlantic Medical Group3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• South Atlantic Medical Group

  • General Practice Physician
  • Huntington Park, CA
  • NPI 1629251541
  NPD tax ID
• South Atlantic Medical Group

  • General Practice Physician
  • Bell Gardens, CA
  • NPI 1710160635
  NPD tax ID

Locations

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1790705267",
    "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",
            "fax_number": "323-725-6933"
        },
        {
            "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",
            "fax_number": "323-725-6933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH ATLANTIC MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2008-07-16",
        "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": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A41061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0020630",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Soheyla Soury, RPH
• Sous Le Parapluie, LLC
• Nagi N. Sous, MD
• Emily Priscilla Sousa, PHD, PPCNP-BC, MPH
• Renato Sousa, DPM
• South Atlantic Medical Group Ipa
• South Atlantic Medical Group, Inc
• South Bay Senior Services Inc
• South Bay Senior Services, Inc
• South Baylo University

• Family Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, 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 Jul 16, 2008; 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.