Provider Demographics
NPI:1124291091
Name:SOUTH COAST MEDICAL & THERAPY, INC.
Entity type:Organization
Organization Name:SOUTH COAST MEDICAL & THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:I-CHUN
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-241-9600
Mailing Address - Street 1:138 N BRAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4617
Mailing Address - Country:US
Mailing Address - Phone:818-241-9600
Mailing Address - Fax:818-941-9601
Practice Address - Street 1:138 N BRAND BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4617
Practice Address - Country:US
Practice Address - Phone:818-241-9600
Practice Address - Fax:818-941-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center