Healthcare Provider Details

I. General information

NPI: 1215150529
Provider Name (Legal Business Name): JOSHUA INTERNATIONAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7872 WALKER STREET SUITE 211
LA PALMA CA
90623
US

IV. Provider business mailing address

7872 WALKER STREET SUITE 211
LA PALMA CA
90623
US

V. Phone/Fax

Practice location:
  • Phone: 714-527-8777
  • Fax: 714-527-8990
Mailing address:
  • Phone: 714-527-8777
  • Fax: 714-527-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JINNI CHAO
Title or Position: ADMIN. ASSISTANT
Credential:
Phone: 714-527-8943