Provider Demographics
NPI:1790424711
Name:GOLDEN OAK MEDICAL GROUP INC
Entity Type:Organization
Organization Name:GOLDEN OAK MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEMCHAND
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-791-1111
Mailing Address - Street 1:1545 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3814
Mailing Address - Country:US
Mailing Address - Phone:951-791-1111
Mailing Address - Fax:888-856-3893
Practice Address - Street 1:36243 INLAND VALLEY DR STE 160
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-9548
Practice Address - Country:US
Practice Address - Phone:951-698-8821
Practice Address - Fax:888-694-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty