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General NPI Number Information
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NPI Number | 1588029771
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Entity Type | Organization
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Legal Business Name | 123 MEDICAL GROUP CORP.
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 18800 AMAR RD STE C12
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City | WALNUT
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State | CA
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Zip | 91789-4561
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Country | US
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Telephone | 626-788-9691
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Fax | 626-608-0318
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Provider Business Mailing Address
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Address Line | 18800 AMAR RD STE C12
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City | WALNUT
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State | CA
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Zip | 91789-4561
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Country | US
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Telephone | 626-788-9691
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Fax | 626-608-0318
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALLAN C CHANG
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Credential | LAC, DOM, DAOM
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Telephone | 626-889-6917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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