Provider Demographics
NPI:1427299858
Name:NEW AGE MED GROUP
Entity type:Organization
Organization Name:NEW AGE MED GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GEBHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-606-9474
Mailing Address - Street 1:1827 XIMENO AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-2850
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1827 XIMENO AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-2850
Practice Address - Country:US
Practice Address - Phone:562-606-9474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-14
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABP013AMedicare PIN