Healthcare Provider Details

I. General information

NPI: 1649324120
Provider Name (Legal Business Name): CENTRAL BRISTOL MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 W CENTRAL AVE SUITE 108
SANTA ANA CA
92707
US

IV. Provider business mailing address

1155 W CENTRAL AVE SUITE 108
SANTA ANA CA
92707
US

V. Phone/Fax

Practice location:
  • Phone: 714-241-8162
  • Fax: 714-241-8163
Mailing address:
  • Phone: 714-241-8162
  • Fax: 714-241-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA36670
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA37133
License Number StateCA

VIII. Authorized Official

Name: NHIEP TANG
Title or Position: OWNER
Credential: MD
Phone: 714-241-8162