Provider Demographics
NPI:1831400795
Name:STRONGKIDS MEDICAL GROUP INC
Entity type:Organization
Organization Name:STRONGKIDS MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-915-4656
Mailing Address - Street 1:PO BOX 8500
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-8500
Mailing Address - Country:US
Mailing Address - Phone:714-542-1331
Mailing Address - Fax:714-542-4758
Practice Address - Street 1:2222 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3220
Practice Address - Country:US
Practice Address - Phone:714-542-1331
Practice Address - Fax:714-542-4758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44664208000000X
COA35731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265521843Medicaid
CA1265494835Medicaid
CA1457368227Medicaid
CA1861796609Medicaid
CA1417179318Medicaid
CA1417179318Medicaid
CACA446AMedicare PIN