Healthcare Provider Details

I. General information

NPI: 1407080468
Provider Name (Legal Business Name): CLINICIANS MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 16TH ST STE B
BAKERSFIELD CA
93301-5002
US

IV. Provider business mailing address

1801 16TH ST STE B
BAKERSFIELD CA
93301-5002
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-8060
  • Fax: 661-326-1349
Mailing address:
  • Phone: 661-326-8060
  • Fax: 661-326-1349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA41492
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA40540
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA24185
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG58099
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA72152
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG28242
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA25213
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA89459
License Number StateCA
# 11
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA47812
License Number StateCA

VIII. Authorized Official

Name: JOHNSON JUNG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-326-8060