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General NPI Number Information
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NPI Number | 1073557377
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Entity Type | Organization
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Legal Business Name | FIRST HEALTHCARE MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12062 VALLEY VIEW ST
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City | GARDEN GROVE
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State | CA
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Zip | 92845-1737
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Country | US
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Telephone | 714-892-2333
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Fax | 714-892-3979
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Provider Business Mailing Address
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Address Line | 12062 VALLEY VIEW ST
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City | GARDEN GROVE
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State | CA
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Zip | 92845-1741
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Country | US
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Telephone | 714-892-2333
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Fax | 714-892-3979
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS HANSON
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Credential | M.D.
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Telephone | 714-892-2333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | W17315
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License Number State | CA
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