Healthcare Provider Details

I. General information

NPI: 1376843771
Provider Name (Legal Business Name): BRISTOL MCFADDEN MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 E MCFADDEN AVE
SANTA ANA CA
92705-4106
US

IV. Provider business mailing address

1226 E MCFADDEN AVE
SANTA ANA CA
92705-4106
US

V. Phone/Fax

Practice location:
  • Phone: 714-245-0288
  • Fax: 714-245-0488
Mailing address:
  • Phone: 714-245-0288
  • Fax: 714-245-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KASIN EKMAHA CHAI
Title or Position: PRESIDENT OF CORPORATION
Credential: M.D.
Phone: 714-966-0646