Healthcare Provider Details

I. General information

NPI: 1114558350
Provider Name (Legal Business Name): KIDSTRONG MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 LAGUNA RD STE 5
FULLERTON CA
92835-2523
US

IV. Provider business mailing address

2618 SAN MIGUEL DR STE 464
NEWPORT BEACH CA
92660-5437
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-2980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GUNJEET KALA AHLUWALIA
Title or Position: PRESIDENT
Credential: MD
Phone: 714-707-0034