Provider Demographics
NPI:1871811448
Name:HAYASA MEDICAL GROUP INC
Entity type:Organization
Organization Name:HAYASA MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:213-382-2063
Mailing Address - Street 1:3540 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 714
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2307
Mailing Address - Country:US
Mailing Address - Phone:213-382-2063
Mailing Address - Fax:213-382-4935
Practice Address - Street 1:3540 WILSHIRE BLVD
Practice Address - Street 2:SUITE 714
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2307
Practice Address - Country:US
Practice Address - Phone:213-382-2063
Practice Address - Fax:213-382-4935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty