Provider Demographics
NPI:1407161326
Name:FOUNTAIN VALLEY HOSPITALIST MEDICAL GROUP
Entity Type:Organization
Organization Name:FOUNTAIN VALLEY HOSPITALIST MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JIN-JOU
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-545-5501
Mailing Address - Street 1:2924 ALTA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3205
Mailing Address - Country:US
Mailing Address - Phone:714-545-5501
Mailing Address - Fax:
Practice Address - Street 1:11770 WARNER AVE
Practice Address - Street 2:SUITE# 208
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2663
Practice Address - Country:US
Practice Address - Phone:714-436-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41229207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty