Healthcare Provider Details

I. General information

NPI: 1386537744
Provider Name (Legal Business Name): LA CANADA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 FOOTHILL BLVD STE C
LA CANADA FLINTRIDGE CA
91011-3282
US

IV. Provider business mailing address

850 COLORADO BLVD STE 201
LOS ANGELES CA
90041-1733
US

V. Phone/Fax

Practice location:
  • Phone: 818-369-7848
  • Fax: 818-671-3521
Mailing address:
  • Phone: 818-369-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AARON I-LUNG JENG
Title or Position: PRESIDENT / OWNER
Credential: MD
Phone: 626-786-1343