Provider Demographics
NPI:1073692406
Name:LEDUC MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:LEDUC MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-540-0105
Mailing Address - Street 1:11160 WARNER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4010
Mailing Address - Country:US
Mailing Address - Phone:714-540-0105
Mailing Address - Fax:714-540-6727
Practice Address - Street 1:11160 WARNER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4010
Practice Address - Country:US
Practice Address - Phone:714-540-0105
Practice Address - Fax:714-540-6727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-05
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFT562AMedicare PIN
CAG56656Medicare PIN
CAFT574ZMedicare PIN