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General NPI Number Information
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NPI Number | 1255103149
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Entity Type | Organization
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Legal Business Name | PCG MEDICAL INSTITUTE CORP.
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 11922 SEACREST DR STE E
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City | GARDEN GROVE
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State | CA
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Zip | 92840-1937
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Country | US
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Telephone | 657-667-0078
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Fax | 209-348-5005
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Provider Business Mailing Address
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Address Line | 11922 SEACREST DR STE E
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City | GARDEN GROVE
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State | CA
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Zip | 92840-1937
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Country | US
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Telephone | 657-667-0078
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Fax | 209-348-5005
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Authorized Official
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Title or Position | CHIEF OPERATION OFFICER
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Name | JAMES PHUONG MINH TRAN
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Credential | MD
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Telephone | 714-342-5398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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