Healthcare Provider Details

I. General information

NPI: 1073692406
Provider Name (Legal Business Name): LEDUC MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2006
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11160 WARNER AVE SUITE 101
FOUNTAIN VALLEY CA
92708-4010
US

IV. Provider business mailing address

11160 WARNER AVE SUITE 101
FOUNTAIN VALLEY CA
92708-4010
US

V. Phone/Fax

Practice location:
  • Phone: 714-540-0105
  • Fax: 714-540-6727
Mailing address:
  • Phone: 714-540-0105
  • Fax: 714-540-6727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: STUART CHUNG
Title or Position: ADMINISTRATOR
Credential:
Phone: 714-540-0105