Healthcare Provider Details

I. General information

NPI: 1922022441
Provider Name (Legal Business Name): MEDFORD ORTHOPAEDIC MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 S GARFIELD AVE SUITE 301
ALHAMBRA CA
91801-4426
US

IV. Provider business mailing address

PO BOX 6217
ALHAMBRA CA
91802-6217
US

V. Phone/Fax

Practice location:
  • Phone: 626-248-9318
  • Fax: 626-248-9329
Mailing address:
  • Phone: 626-248-9318
  • Fax: 626-248-9329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG078679
License Number StateCA

VIII. Authorized Official

Name: JEAN DING
Title or Position: PRESIDENT
Credential: MD
Phone: 626-248-9318