Provider Demographics
NPI:1215372040
Name:DOCTORS CHOICE MEDICAL GROUP
Entity Type:Organization
Organization Name:DOCTORS CHOICE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAN
Authorized Official - Middle Name:NHU BICH
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-399-8996
Mailing Address - Street 1:2295-A HUNTINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108
Mailing Address - Country:US
Mailing Address - Phone:818-399-8996
Mailing Address - Fax:
Practice Address - Street 1:2295-A HUNTINGTON DRIVE
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108
Practice Address - Country:US
Practice Address - Phone:818-399-8996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization