Provider Demographics
NPI:1801049697
Name:LOS ANGELES EAR MEDICAL GROUP
Entity type:Organization
Organization Name:LOS ANGELES EAR MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-574-6921
Mailing Address - Street 1:622 W DUARTE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7606
Mailing Address - Country:US
Mailing Address - Phone:626-574-6921
Mailing Address - Fax:626-574-9604
Practice Address - Street 1:622 W DUARTE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7606
Practice Address - Country:US
Practice Address - Phone:626-574-6921
Practice Address - Fax:626-574-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52831207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ75134ZMedicaid