Provider Demographics
NPI:1427710763
Name:GUARDIAN PHYSICIAN OVERSIGHT INC.
Entity type:Organization
Organization Name:GUARDIAN PHYSICIAN OVERSIGHT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DOSUMU
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-953-9759
Mailing Address - Street 1:324 S BEVERLY DR # 214
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4801
Mailing Address - Country:US
Mailing Address - Phone:310-953-9759
Mailing Address - Fax:
Practice Address - Street 1:5100 COLONY PLZ
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6347
Practice Address - Country:US
Practice Address - Phone:310-953-9759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty