Provider Demographics
NPI:1649324120
Name:CENTRAL BRISTOL MEDICAL GROUP INC
Entity type:Organization
Organization Name:CENTRAL BRISTOL MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NHIEP
Authorized Official - Middle Name:
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-241-8162
Mailing Address - Street 1:1155 W CENTRAL AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707
Mailing Address - Country:US
Mailing Address - Phone:714-241-8162
Mailing Address - Fax:714-241-8163
Practice Address - Street 1:1155 W CENTRAL AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707
Practice Address - Country:US
Practice Address - Phone:714-241-8162
Practice Address - Fax:714-241-8163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA366702085R0202X
CAA37133208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A371330Medicaid
WA87133BMedicare UPIN
A37133Medicare ID - Type Unspecified