Provider Demographics
NPI:1972724326
Name:SOUTH BAY OTOLARYNGOLOGY HEAD AND NECK SURGERY A MEDICAL CORPORATION
Entity type:Organization
Organization Name:SOUTH BAY OTOLARYNGOLOGY HEAD AND NECK SURGERY A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NELMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-370-5555
Mailing Address - Street 1:20911 EARL ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4352
Mailing Address - Country:US
Mailing Address - Phone:310-370-5555
Mailing Address - Fax:310-370-0133
Practice Address - Street 1:20911 EARL ST
Practice Address - Street 2:SUITE 260
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4352
Practice Address - Country:US
Practice Address - Phone:310-370-5555
Practice Address - Fax:310-370-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14104Medicare PIN