Healthcare Provider Details

I. General information

NPI: 1376412262
Provider Name (Legal Business Name): PACIFIC ORTHOPAEDIC MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18605 GALE AVE STE 168
CITY OF INDUSTRY CA
91748-1344
US

IV. Provider business mailing address

707 S GARFIELD AVE STE 201
ALHAMBRA CA
91801-5861
US

V. Phone/Fax

Practice location:
  • Phone: 626-282-1600
  • Fax: 626-656-1261
Mailing address:
  • Phone: 626-282-1600
  • Fax: 626-656-1261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SARAH P DU
Title or Position: ACCOUNT RECEIVABLE MANAGER
Credential:
Phone: 626-656-1324