EXECUTIVE INTERGRATED MEDICAL GROUP, INC. (NPI# 1326575812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326575812 |
| Entity Type | Organization |
| Organization Name | EXECUTIVE INTERGRATED MEDICAL GROUP, INC. |
| Practice Address |
3605 Long Beach Blvd Ste 304 Long Beach CA 90807-6018 |
| Practice Telephone | (310) 559-5916 |
| Practice Fax Number | 3105595466 |
| Mailing Telephone | 3105595916 |
| Mailing Fax Number | 3105595466 |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2017-10-25 |
| Authorized Official Name | DR. KAMAL BIJANPOUR (PRESIDENT / CEO) |
| Authorized Official Telephone | 3105595916 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 2084P0805X |
Psychiatry & Neurology Specialization: Geriatric Psychiatry |
A109162 | CA | Allopathic & Osteopathic Physicians |
| Y | 2084P0802X |
Psychiatry & Neurology Specialization: Addiction Psychiatry |
A109162 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
3605 LONG BEACH BLVD STE 304 |
| City | LONG BEACH |
| State | CA |
| Zip Code | 90807-6018 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598903858 | Kamal Bijanpour | Psychiatry & Neurology | 3605 Long Beach Blvd Ste 304, Long Beach, CA 90807-6018 | 2009-01-25 |
| 1265873855 | Kamalbijanpour Inc | Psychiatry & Neurology | 3605 Long Beach Blvd Ste 304, Long Beach, CA 90807-6018 | 2013-07-11 |
| 1699118752 | Kamal Bijanpour Inc | Psychiatry & Neurology | 3605 Long Beach Blvd Ste 304, Long Beach, CA 90807-6018 | 2013-04-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992359434 | Kanna Lynn Curtis | Behavioral Analyst | 3491 Elm Avenue, Long Beach, CA 90807 | 2019-08-01 |
| 1891359394 | David Smith Samuel Tchon Dds Inc | Dentist | 4231 Long Beach Blvd, Long Beach, CA 90807 | 2019-04-30 |
| 1477038354 | Ryan Bacani | Registered Nurse | 4506 N Banner Drive Apt 3, Long Beach, CA 90807 | 2018-09-26 |
| 1508363516 | Joemari Salvani | Dentist | 4578 Atlantic Avenue, Long Beach, CA 90807 | 2018-04-07 |
| 1881110096 | Shafeeullah Hashim Gaines | Counselor | 4335 Altantic Ave, Long Beach, CA 90807 | 2017-08-18 |
| 1295259943 | Debresia Jackson | Community Health Worker | 900 E. Wardlow Rd, Long Beach, CA 90807 | 2017-08-02 |
| 1073036315 | United Mobile Rad LLC | Radiologic Technologist | 1720 E Cartagena St, Long Beach, CA 90807 | 2017-07-19 |
| 1336675800 | La-pham and Kansagra Dental Corporation | Dentist | 4578 Atlantic Ave, Long Beach, CA 90807 | 2017-05-03 |
| 1114462637 | Andunett Langhum | Counselor | 4335 Atlantic Blved, Long Beach, CA 90807 | 2016-12-20 |
| 1942742507 | Mt Medical Transportation LLC | Non-emergency Medical Transport (VAN) | 3646 Long Beach Blvd Ste 212, Long Beach, CA 90807 | 2016-11-14 |
| Find all providers in zip 90807 | ||||
| Taxonomy Code | 2084P0802X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Psychiatry |
| Addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093894438 | Ronald Clark Golinger | Psychiatry & Neurology | 58 Barnes St, Long Beach, NY 11561-2615 | 2006-11-05 |
| 1881782092 | James Harold Barger | Psychiatry & Neurology | 1310 E Ocean Blvd, #607, Long Beach, CA 90802-6900 | 2006-10-11 |
| 1558478941 | Mark Leonard Katz | Psychiatry & Neurology | 5901 E 7th St, Mailcode #006/116a - Mental Health Cg, Long Beach, CA 90822-5201 | 2006-08-23 |
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|---|---|---|---|---|
| 1184111494 | Lags Spine and Sportscare Medical Centers, Inc. | Psychiatry & Neurology | 1223 Higuera St Ste 101, San Luis Obispo, CA 93401-3167 | 2018-04-23 |
| 1053808899 | Klc Consultants, PC | Psychiatry & Neurology | 1808 Verdugo Blvd Ste 319, Glendale, CA 91208-1486 | 2018-04-17 |
| 1780196733 | Acceptance Detox LLC | Psychiatry & Neurology | 18779 Palm St, Fountain Valley, CA 92708-6428 | 2017-10-31 |
| 1952824021 | Novation Behavioral Health, LLC | Psychiatry & Neurology | 1707 E Bay Ave, Newport Beach, CA 92661-1453 | 2017-07-20 |
| 1912362567 | Sanjoy Sathpathy, M.d. Inc | Psychiatry & Neurology | 9888 Carroll Center Road, 218, San Diego, CA 92126-4515 | 2015-12-28 |
| 1043562630 | San Diego Professional Group, P. C. | Psychiatry & Neurology | 41655 Date St, Suite 101a, Murrieta, CA 92562-7040 | 2012-10-08 |
| 1841591690 | David E. Brody | Psychiatry & Neurology | 13200 South Bloomfield Ave, Norwalk, CA 90650 | 2010-11-10 |
| 1124342647 | Vicki Kalira | Psychiatry & Neurology | 150 Muir Rd Bldg 24, Martinez, CA 94553-4668 | 2010-03-26 |
| 1710127964 | Pacific Composure Psychiatry & Hypnotherapy | Psychiatry & Neurology | 180 7th Ave Ste 103, Santa Cruz, CA 95062-4732 | 2009-02-28 |
| 1235341330 | Timmen Cermak | Psychiatry & Neurology | 239 Miller Avenue, Suite #1, Mill Valley, CA 94941 | 2007-05-03 |
| Find all providers with the same taxonomy | ||||
| City | LONG BEACH |
| Zip Code | 90807 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.