Provider Demographics
NPI:1083159057
Name:ALLCARE FAMILY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:ALLCARE FAMILY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:TAEHUNG
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-525-9900
Mailing Address - Street 1:6301 BEACH BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2840
Mailing Address - Country:US
Mailing Address - Phone:714-525-9900
Mailing Address - Fax:714-228-9228
Practice Address - Street 1:6301 BEACH BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2840
Practice Address - Country:US
Practice Address - Phone:714-525-9900
Practice Address - Fax:714-228-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-30
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI16672Medicare UPIN