Provider Demographics
NPI:1528231362
Name:FAMILY FIRST MEDICAL GROUP
Entity Type:Organization
Organization Name:FAMILY FIRST MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-794-8098
Mailing Address - Street 1:456 E ORANGE GROVE BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-5235
Mailing Address - Country:US
Mailing Address - Phone:626-683-8818
Mailing Address - Fax:626-683-1103
Practice Address - Street 1:456 E ORANGE GROVE BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-5234
Practice Address - Country:US
Practice Address - Phone:626-683-8818
Practice Address - Fax:626-683-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28806208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0062970Medicare PIN