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General NPI Number Information
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NPI Number | 1093094930
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Entity Type | Organization
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Legal Business Name | STRONGKIDS MEDICAL GROUP, INC
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 12665 GARDEN GROVE BLVD SUITE 713
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1901
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Country | US
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Telephone | 714-537-6595
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Fax | 714-537-2176
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Provider Business Mailing Address
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Address Line | PO BOX 8500
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City | NEWPORT BEACH
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State | CA
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Zip | 92658-8500
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JACOB SWEIDAN
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Credential | M.D.
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Telephone | 714-537-6595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A44664
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License Number State | CA
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