Provider Demographics
NPI:1114459302
Name:STRONGKIDS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:STRONGKIDS MEDICAL GROUP, INC.
Other - Org Name:STRONG FAMILIES MEDICAL GROUP, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-714-4567
Mailing Address - Street 1:136 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2818
Mailing Address - Country:US
Mailing Address - Phone:949-873-5537
Mailing Address - Fax:
Practice Address - Street 1:136 BROADWAY
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2818
Practice Address - Country:US
Practice Address - Phone:949-873-5537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44664261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care