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General NPI Number Information
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NPI Number | 1104044288
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Entity Type | Organization
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Legal Business Name | ST. MARTIN FAMILY MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 12555 GARDEN GROVE BLVD STE 506
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1904
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Country | US
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Telephone | 714-537-3900
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Fax | 714-537-7300
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Provider Business Mailing Address
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Address Line | 12555 GARDEN GROVE BLVD STE 506
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1904
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Country | US
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Telephone | 714-537-3900
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Fax | 714-537-7300
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Authorized Official
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Title or Position | DIRECT OWNER
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Name | DR. HUNG NGUYEN
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Credential | M.D
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Telephone | 714-537-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | A61958
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License Number State | CA
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