Provider Demographics
NPI:1912929852
Name:PIONERR MEDICAL GROUP INC
Entity Type:Organization
Organization Name:PIONERR MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-229-9452
Mailing Address - Street 1:PO BOX 1682
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90707-1682
Mailing Address - Country:US
Mailing Address - Phone:562-229-9452
Mailing Address - Fax:562-920-4642
Practice Address - Street 1:16510 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2115
Practice Address - Country:US
Practice Address - Phone:562-229-0902
Practice Address - Fax:562-229-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00376ZOtherBLUE SHIELD
CAGR0090424Medicaid