Provider Demographics
NPI:1245546985
Name:DMG COMMUNITY MEDICAL CLINIC
Entity type:Organization
Organization Name:DMG COMMUNITY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, CCM, CPHQ, NP-C
Authorized Official - Phone:626-607-1696
Mailing Address - Street 1:3318 DEL MAR AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2373
Mailing Address - Country:US
Mailing Address - Phone:626-607-1696
Mailing Address - Fax:626-571-7405
Practice Address - Street 1:3318 DEL MAR AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2373
Practice Address - Country:US
Practice Address - Phone:626-607-1696
Practice Address - Fax:626-571-7405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP18574261QP2300X, 261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care