Provider Demographics
NPI:1922022441
Name:MEDFORD ORTHOPAEDIC MEDICAL CORP
Entity Type:Organization
Organization Name:MEDFORD ORTHOPAEDIC MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-248-9318
Mailing Address - Street 1:PO BOX 6217
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91802-6217
Mailing Address - Country:US
Mailing Address - Phone:626-248-9318
Mailing Address - Fax:626-248-9329
Practice Address - Street 1:723 S GARFIELD AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4426
Practice Address - Country:US
Practice Address - Phone:626-248-9318
Practice Address - Fax:626-248-9329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG078679207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G786791Medicaid
CA4748980001Medicare NSC
CA00G786791Medicaid
CAW16348Medicare PIN