Healthcare Provider Details

I. General information

NPI: 1922993815
Provider Name (Legal Business Name): MEDWELL CLINIC PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7695 WESTMINSTER BLVD
WESTMINSTER CA
92683-3921
US

IV. Provider business mailing address

7695 WESTMINSTER BLVD
WESTMINSTER CA
92683-3921
US

V. Phone/Fax

Practice location:
  • Phone: 714-383-0661
  • Fax:
Mailing address:
  • Phone: 714-872-8071
  • Fax: 714-872-8702

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 Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: TRANG MINH VU
Title or Position: MANAGER/CFO
Credential: FNP-C
Phone: 714-383-0661