Healthcare Provider Details

I. General information

NPI: 1649015942
Provider Name (Legal Business Name): GOOD SAMARITAN MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 MARKET ST STE C
RIVERSIDE CA
92501-3567
US

IV. Provider business mailing address

4343 MARKET ST STE C
RIVERSIDE CA
92501-3567
US

V. Phone/Fax

Practice location:
  • Phone: 951-784-7406
  • Fax: 951-784-7409
Mailing address:
  • Phone: 951-784-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VIEN D DOAN
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 951-784-7406