| Organization Name: | BEVERLY GARDEN MEDICAL GROUP, INC. |
| NPI Number: | 1225452048 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FRED SAHAFI (MEDICAL DIRECTOR/ OWNER) |
| Mailing Address: | 7916 Eastern Ave Ste 102 Bell Gardens |
| State: | CA US |
| Postal Code: | 902015464 |
| Phone Number: | 5629287060 |
| Fax Number: | 5629287090 |
| NPI Enumeration Date: | 02/13/2014 |
| NPI Last Update Date: | 11/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 00170368 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |