Provider Demographics
NPI:1841466927
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
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-947-8600
Mailing Address - Street 1:6261 KATELLA AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5249
Mailing Address - Country:US
Mailing Address - Phone:714-947-8692
Mailing Address - Fax:714-947-8792
Practice Address - Street 1:1226 E MCFADDEN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4106
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:2008-05-07
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A446640Medicaid
CA00A357310Medicaid
CA00PA142210Medicaid
CAGR0105312Medicaid
CAWA35731EMedicare PIN
CAP42193Medicare UPIN
CAGR0105312Medicaid
CAWPA14221JMedicare PIN