Provider Demographics
NPI:1891985289
Name:PREFERRED MEDICAL GROUP INC
Entity Type:Organization
Organization Name:PREFERRED MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-576-7871
Mailing Address - Street 1:1234 S GARFIELD AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5065
Mailing Address - Country:US
Mailing Address - Phone:626-576-7871
Mailing Address - Fax:626-576-7872
Practice Address - Street 1:1234 S GARFIELD AVE
Practice Address - Street 2:STE 103
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5065
Practice Address - Country:US
Practice Address - Phone:626-576-7871
Practice Address - Fax:626-576-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A676780Medicaid
CAH14784Medicare UPIN
CAA67678Medicare PIN