Provider Demographics
NPI:1063858454
Name:TEMECULA VALLEY DIGESTIVE DISEASE CONSULTANTS A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:TEMECULA VALLEY DIGESTIVE DISEASE CONSULTANTS A MEDICAL CORPORATION
Other - Org Name:UNITED GASTROENTEROLOGISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-566-5229
Mailing Address - Street 1:28078 BAXTER RD
Mailing Address - Street 2:SUITE 530
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-1402
Mailing Address - Country:US
Mailing Address - Phone:951-566-5229
Mailing Address - Fax:951-566-5554
Practice Address - Street 1:521 E ELDER ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3081
Practice Address - Country:US
Practice Address - Phone:951-566-5229
Practice Address - Fax:951-566-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA2772207L00000X
CANA3360207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty