Provider Demographics
NPI:1710345095
Name:PACIFIC BEACH MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:PACIFIC BEACH MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:TANG
Authorized Official - Last Name:KIET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-847-3700
Mailing Address - Street 1:16111 BEACH BLVD.
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647
Mailing Address - Country:US
Mailing Address - Phone:714-847-3700
Mailing Address - Fax:714-847-3711
Practice Address - Street 1:16111 BEACH BLVD.
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647
Practice Address - Country:US
Practice Address - Phone:714-847-3700
Practice Address - Fax:714-847-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty