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NPI Code Detail

MEDICARE: JOSEPH MEDICAL GROUP, INC.

MEDICARE: JOSEPH MEDICAL GROUP, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332900000XNon-Pharmacy Dispensing SiteG61950CA

General Provider Information

NPI Number : 1760755839
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOSEPH MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : 5626 OBERLIN DR
Second Line : SUITE 110
City : SAN DIEGO
State : CA
Zip : 92121-1705
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6261 STANTON AVE
Second Line :
City : BUENA PARK
State : CA
Zip : 90621-2436
Country : US
Telephone Number : 714-739-4325
Fax Number :
Authorized Official
Title or Position : SR DIRECTOR OPS
Name : KENNY HEINE
Credential :
Telephone Number : 858-964-1506
Provider Enumeration Date : 02/20/2012
Last Update Date : 10/25/2012

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