Provider Demographics
NPI:1417463563
Name:ROS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ROS MEDICAL GROUP INC
Other - Org Name:ROS MEDICAL GROUP - SAN GABRIEL
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SINGH
Authorized Official - Middle Name:AHN
Authorized Official - Last Name:BOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-382-1263
Mailing Address - Street 1:409 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3433
Mailing Address - Country:US
Mailing Address - Phone:626-382-1263
Mailing Address - Fax:626-382-1252
Practice Address - Street 1:1730 S SAN GABRIEL BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3928
Practice Address - Country:US
Practice Address - Phone:626-573-1252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROS MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty