Healthcare Provider Details

I. General information

NPI: 1245546985
Provider Name (Legal Business Name): DMG COMMUNITY MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3318 DEL MAR AVE SUITE 205
ROSEMEAD CA
91770-2373
US

IV. Provider business mailing address

3318 DEL MAR AVE SUITE 205
ROSEMEAD CA
91770-2373
US

V. Phone/Fax

Practice location:
  • Phone: 626-607-1696
  • Fax: 626-571-7405
Mailing address:
  • Phone: 626-607-1696
  • Fax: 626-571-7405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberNP18574
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberNP18574
License Number StateCA

VIII. Authorized Official

Name: MS. HELEN SUN
Title or Position: PRESIDENT
Credential: MSN, CCM, CPHQ, NP-C
Phone: 626-607-1696