Provider Demographics
NPI:1437360047
Name:POTENTIAL MEDICAL GROUP
Entity Type:Organization
Organization Name:POTENTIAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-280-9995
Mailing Address - Street 1:616 N GARFIELD AVE
Mailing Address - Street 2:203
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1141
Mailing Address - Country:US
Mailing Address - Phone:626-280-9995
Mailing Address - Fax:
Practice Address - Street 1:616 N GARFIELD AVE
Practice Address - Street 2:203
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1141
Practice Address - Country:US
Practice Address - Phone:626-280-9995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG072009173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty