Provider Demographics
NPI:1205161395
Name:BEACH CITIES MEDICAL GROUP
Entity type:Organization
Organization Name:BEACH CITIES MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NIKOLAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:CHUGAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:562-595-8507
Mailing Address - Street 1:4210 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2802
Mailing Address - Country:US
Mailing Address - Phone:562-595-8507
Mailing Address - Fax:562-988-9220
Practice Address - Street 1:4210 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2802
Practice Address - Country:US
Practice Address - Phone:562-595-8507
Practice Address - Fax:562-988-9220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16520 AAAHC,INC261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16520OtherACCREDITATION ASSOCIATION FOR AMBULATORY HEALTH CARE, INC.