Healthcare Provider Details

I. General information

NPI: 1730567579
Provider Name (Legal Business Name): GCH MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 TERMINO AVE
LONG BEACH CA
90804-2104
US

IV. Provider business mailing address

PO BOX 35145 #1021
SEATTLE WA
98124-5145
US

V. Phone/Fax

Practice location:
  • Phone: 747-283-1809
  • Fax:
Mailing address:
  • Phone: 747-283-1809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILIP J. FAGAN JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 747-283-1809