Organization · NPI-2
123 Medical Group Corp.
Family Medicine · Walnut, CA
NPI number1588029771
StatusActive
Last updated in NPPESAug 9, 2022
Details
- NPI
- 1588029771
- Entity type
- Organization (NPI-2)
- Legal business name
- 123 Medical Group Corp.
- Organization subpart
- No
- Enumeration date
- Dec 15, 2015
- Certification date
- Aug 9, 2022
- Last updated
- Aug 9, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
| 171100000X | Acupuncturist | – | – | |
| 207V00000X | Obstetrics & Gynecology | – | – |
Practice location
18800 Amar Rd Ste C12Walnut, CA 91789-4561
Phone 626-788-9691 · Fax 626-608-0318
Mailing address
18800 Amar Rd Ste C12Walnut, CA 91789-4561
Phone 626-788-9691 · Fax 626-608-0318
Authorized official
Allan C Chang
President
6268896917
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