Provider Demographics
NPI:1003336041
Name:AAA MEDICAL GROUP
Entity Type:Organization
Organization Name:AAA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:QUANG
Authorized Official - Middle Name:BINH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-360-5714
Mailing Address - Street 1:13071 BROOKHURST ST STE 110
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1047
Mailing Address - Country:US
Mailing Address - Phone:714-360-5714
Mailing Address - Fax:
Practice Address - Street 1:13071 BROOKHURST ST STE 110
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1047
Practice Address - Country:US
Practice Address - Phone:714-360-5714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64392207Q00000X, 207Y00000X
CACB267742207Q00000X
CAE4237213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB267742OtherMEDICARE PTAN
CAE4237OtherMEDICARE PTAN
CAA64392OtherMEDICARE PTAN