Provider Demographics
NPI:1942593348
Name:AFFILIATED PHYSICIANS MEDICAL GROUP
Entity Type:Organization
Organization Name:AFFILIATED PHYSICIANS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAN
Authorized Official - Middle Name:NHU BICH
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:626-656-2370
Mailing Address - Street 1:2360 HUNTINGTON DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2651
Mailing Address - Country:US
Mailing Address - Phone:626-656-2370
Mailing Address - Fax:626-248-9060
Practice Address - Street 1:2360 HUNTINGTON DR STE 201
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2651
Practice Address - Country:US
Practice Address - Phone:626-656-2370
Practice Address - Fax:626-248-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization