Provider Demographics
NPI:1568670271
Name:EDU MEDICAL GROUP
Entity Type:Organization
Organization Name:EDU MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINEDU
Authorized Official - Middle Name:J
Authorized Official - Last Name:UGORJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-263-1112
Mailing Address - Street 1:PO BOX 794
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92334-0794
Mailing Address - Country:US
Mailing Address - Phone:310-263-1112
Mailing Address - Fax:310-263-1113
Practice Address - Street 1:4555 W ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6935
Practice Address - Country:US
Practice Address - Phone:310-263-1112
Practice Address - Fax:310-263-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA80759AMedicare ID - Type Unspecified