Provider Demographics
NPI:1134318926
Name:MEDFORD ORTHOPAEDIC MEDICAL CORP
Entity type:Organization
Organization Name:MEDFORD ORTHOPAEDIC MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANHTHU
Authorized Official - Middle Name:
Authorized Official - Last Name:HANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-247-2250
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:626-247-2250
Mailing Address - Fax:626-247-2259
Practice Address - Street 1:301 W HUNTINGTON DR STE 617
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-1518
Practice Address - Country:US
Practice Address - Phone:626-247-2250
Practice Address - Fax:626-247-2259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78679207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G786791Medicaid
X87837Medicare UPIN
CA00G786791Medicaid
CAW16348Medicare PIN