Provider Demographics
NPI:1295935203
Name:CHILDREN FIRST PEDIATRIC GROUP OF DUARTE, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:CHILDREN FIRST PEDIATRIC GROUP OF DUARTE, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-357-4600
Mailing Address - Street 1:2329 E. HUNTINGTON DR.
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010
Mailing Address - Country:US
Mailing Address - Phone:626-357-4600
Mailing Address - Fax:626-357-4661
Practice Address - Street 1:2329 E. HUNTINGTON DR.
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010
Practice Address - Country:US
Practice Address - Phone:626-357-4600
Practice Address - Fax:626-357-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28806208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE01703Medicare UPIN