Provider Demographics
NPI:1164665097
Name:PRESTIGE MULTI-SPECIALTY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:PRESTIGE MULTI-SPECIALTY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-462-1479
Mailing Address - Street 1:1049 PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-6131
Mailing Address - Country:US
Mailing Address - Phone:626-462-1479
Mailing Address - Fax:
Practice Address - Street 1:1049 PANORAMA DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-6131
Practice Address - Country:US
Practice Address - Phone:626-462-1479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty