Healthcare Provider Details

I. General information

NPI: 1679083026
Provider Name (Legal Business Name): TELEHEALTH MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12620 BROOKHURST ST STE 2
GARDEN GROVE CA
92840
US

IV. Provider business mailing address

615 E CHAPMAN AVE
ORANGE CA
92866-1643
US

V. Phone/Fax

Practice location:
  • Phone: 657-251-0453
  • Fax: 657-251-0783
Mailing address:
  • Phone: 714-639-4012
  • Fax: 714-639-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYN JARALD HENDERSON
Title or Position: OWNER
Credential: DO
Phone: 714-639-4012