Healthcare Provider Details

I. General information

NPI: 1457631640
Provider Name (Legal Business Name): FOUNDATION MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4511 ROSEMEAD BLVD
PICO RIVERA CA
90660-2032
US

IV. Provider business mailing address

4511 ROSEMEAD BLVD
PICO RIVERA CA
90660-2032
US

V. Phone/Fax

Practice location:
  • Phone: 562-695-2282
  • Fax: 562-695-7252
Mailing address:
  • Phone: 562-695-2282
  • Fax: 562-695-7252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA40390
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA25158
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA33354
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KHALID BASHIR AHMED
Title or Position: OWNER
Credential: M.D.
Phone: 562-695-2282