Healthcare Provider Details

I. General information

NPI: 1134318926
Provider Name (Legal Business Name): MEDFORD ORTHOPAEDIC MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W HUNTINGTON DR STE 617
ARCADIA CA
91007-1518
US

IV. Provider business mailing address

PO BOX 6217
ALHAMBRA CA
91802-6217
US

V. Phone/Fax

Practice location:
  • Phone: 626-247-2250
  • Fax: 626-247-2259
Mailing address:
  • Phone: 626-247-2250
  • Fax: 626-247-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG78679
License Number StateCA

VIII. Authorized Official

Name: MRS. ANHTHU HANG
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 626-247-2250