Provider Demographics
NPI:1558448795
Name:ADVANCED GI CONSULTANTS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ADVANCED GI CONSULTANTS MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YEONG AN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-399-0556
Mailing Address - Street 1:4314 W VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1334
Mailing Address - Country:US
Mailing Address - Phone:818-845-1854
Mailing Address - Fax:626-289-5686
Practice Address - Street 1:4314 W VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1334
Practice Address - Country:US
Practice Address - Phone:818-845-1854
Practice Address - Fax:626-289-5686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72217207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A722170Medicaid
W18600Medicare ID - Type Unspecified
H17059Medicare UPIN