Provider Demographics
NPI:1568471688
Name:SOUTHERN CALIFORNIA ENDOCRINE MEDICAL GROUP, PMC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA ENDOCRINE MEDICAL GROUP, PMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-997-5000
Mailing Address - Street 1:1310 W STEWART DR STE 215
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3837
Mailing Address - Country:US
Mailing Address - Phone:714-997-5000
Mailing Address - Fax:714-997-5300
Practice Address - Street 1:1310 W STEWART DR STE 215
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3837
Practice Address - Country:US
Practice Address - Phone:714-997-5000
Practice Address - Fax:714-997-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH49370Medicare UPIN