Provider Demographics
NPI:1982715355
Name:ALL FAMILY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ALL FAMILY MEDICAL GROUP INC
Other - Org Name:FAMILY WELLNESS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHODSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-662-1515
Mailing Address - Street 1:220 W 1ST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5262
Mailing Address - Country:US
Mailing Address - Phone:714-550-7001
Mailing Address - Fax:714-550-7006
Practice Address - Street 1:220 W 1ST ST STE 102
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5262
Practice Address - Country:US
Practice Address - Phone:714-550-7001
Practice Address - Fax:714-550-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ55402ZOtherBLUE SHIELD NUMBER
CAGR0079300Medicaid
CAGR0079300Medicaid