Healthcare Provider Details

I. General information

NPI: 1295711224
Provider Name (Legal Business Name): JOSEPH MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6261 STANTON AVE
BUENA PARK CA
90621-2436
US

IV. Provider business mailing address

6261 STANTON AVE
BUENA PARK CA
90621-2436
US

V. Phone/Fax

Practice location:
  • Phone: 714-739-4325
  • Fax: 714-739-4076
Mailing address:
  • Phone: 714-739-4325
  • Fax: 714-739-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG61950
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA80586
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA82873
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG61950
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG61950
License Number StateCA

VIII. Authorized Official

Name: MR. JOSEPH D. CHUN
Title or Position: PRESIDENT/DIRECTOR
Credential: MD
Phone: 714-739-4325