Healthcare Provider Details

I. General information

NPI: 1528231362
Provider Name (Legal Business Name): FAMILY FIRST MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 E ORANGE GROVE BLVD SUITE 120
PASADENA CA
91104-5234
US

IV. Provider business mailing address

456 E ORANGE GROVE BLVD SUITE 120
PASADENA CA
91104-5235
US

V. Phone/Fax

Practice location:
  • Phone: 626-683-8818
  • Fax: 626-683-1103
Mailing address:
  • Phone: 626-683-8818
  • Fax: 626-683-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC28806
License Number StateCA

VIII. Authorized Official

Name: DR. LIONEL P NG
Title or Position: PRESIDENT
Credential: MD
Phone: 626-794-8098