Healthcare Provider Details

I. General information

NPI: 1255103149
Provider Name (Legal Business Name): PCG MEDICAL INSTITUTE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11922 SEACREST DR STE E
GARDEN GROVE CA
92840-1937
US

IV. Provider business mailing address

11922 SEACREST DR STE E
GARDEN GROVE CA
92840-1937
US

V. Phone/Fax

Practice location:
  • Phone: 657-667-0078
  • Fax: 209-348-5005
Mailing address:
  • Phone: 657-667-0078
  • Fax: 209-348-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES PHUONG MINH TRAN
Title or Position: CHIEF OPERATION OFFICER
Credential: MD
Phone: 714-342-5398