Provider Demographics
NPI:1316026826
Name:ROYAL MEDICAL GROUP
Entity Type:Organization
Organization Name:ROYAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GHANSHYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LOHIYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-444-4448
Mailing Address - Street 1:1120 W WARNER AV
Mailing Address - Street 2:#A
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707
Mailing Address - Country:US
Mailing Address - Phone:714-444-4448
Mailing Address - Fax:714-444-9892
Practice Address - Street 1:1120 W WARNER AV
Practice Address - Street 2:#A
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707
Practice Address - Country:US
Practice Address - Phone:714-444-4448
Practice Address - Fax:714-444-9892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA412592083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A412590Medicaid
A85592Medicare UPIN
CA00A412590Medicaid