Organization · NPI-2

365 Medical Group, INC

Internal Medicine · Garden Grove, CA

NPI number1780275016
StatusActive
Last updated in NPPESJan 29, 2021

Details

NPI
1780275016
Entity type
Organization (NPI-2)
Legal business name
365 Medical Group, INC
Organization subpart
No
Enumeration date
Jan 29, 2021
Certification date
Jan 29, 2021
Last updated
Jan 29, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine––Yes

Practice location

12865 Main St Ste 204
Garden Grove, CA 92840-8200

Phone 714-360-0739

Mailing address

12865 Main St Ste 204
Garden Grove, CA 92840-8200

Phone 714-360-0739

Authorized official

Tan Nguyen
Owner
7143600739

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