Provider Demographics
NPI:1518388917
Name:BETHEL MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:BETHEL MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-534-1112
Mailing Address - Street 1:9535 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1550
Mailing Address - Country:US
Mailing Address - Phone:714-534-1112
Mailing Address - Fax:714-534-1116
Practice Address - Street 1:9535 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1550
Practice Address - Country:US
Practice Address - Phone:714-534-1112
Practice Address - Fax:714-534-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34173OtherMEDICAL BOARD OF CALIFORNIA