Provider Demographics
NPI:1043316730
Name:ORTHOPEDIC CENTER FOR EXCELLENCE MEDICAL GROUP A MEDICAL CORP
Entity type:Organization
Organization Name:ORTHOPEDIC CENTER FOR EXCELLENCE MEDICAL GROUP A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SADAO
Authorized Official - Last Name:HAMADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-540-3145
Mailing Address - Street 1:21500 PIONEER BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716-2600
Mailing Address - Country:US
Mailing Address - Phone:310-540-3145
Mailing Address - Fax:310-540-2306
Practice Address - Street 1:21500 PIONEER BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2600
Practice Address - Country:US
Practice Address - Phone:310-540-3145
Practice Address - Fax:310-540-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30470207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A34275Medicare UPIN
A34275Medicare UPIN
CAOOC304700Medicaid
W14084OtherMEDICARE GROUP PROVIDER N
CAC30470Medicaid
CAW14084AMedicare ID - Type Unspecified
CAWC30470GMedicare PIN