Provider Demographics
NPI:1376063461
Name:WOUND MASTERS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:WOUND MASTERS MEDICAL GROUP INC
Other - Org Name:WOUND MASTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NKWAIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:NGAMFON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-400-9942
Mailing Address - Street 1:25044 PEACHLAND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-5730
Mailing Address - Country:US
Mailing Address - Phone:661-383-7136
Mailing Address - Fax:818-356-4380
Practice Address - Street 1:1131 W 6TH ST STE 250
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1108
Practice Address - Country:US
Practice Address - Phone:833-362-7837
Practice Address - Fax:714-805-8923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2022-04-01
Deactivation Date:2021-01-27
Deactivation Code:
Reactivation Date:2021-02-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty