Basic Information
| Provider Information | |||||||||
| NPI: | 1801347273 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOSEPH MEDICAL GROUP INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | JOSEPH MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6261 STANTON AVE | ||||||||
| Address2: | |||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906212436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147394325 | ||||||||
| FaxNumber: | 7147394076 | ||||||||
| Practice Location | |||||||||
| Address1: | 6261 STANTON AVE | ||||||||
| Address2: | |||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906212436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147394325 | ||||||||
| FaxNumber: | 7147394076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2016 | ||||||||
| LastUpdateDate: | 10/20/2016 | ||||||||
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| AuthorizedOfficialLastName: | YANG | ||||||||
| AuthorizedOfficialFirstName: | MIRIAM | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 7147394325 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | G61950 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.