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General NPI Number Information
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NPI Number | 1902946585
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Entity Type | Organization
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Legal Business Name | TMG MEDICAL GROUP, INC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 11/13/2015
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Provider Practice Location Address
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Address Line | 17834 MIRANDA ST
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City | ENCINO
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State | CA
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Zip | 91316-1115
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Country | US
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Telephone | 818-600-8193
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Fax | 818-600-8194
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Provider Business Mailing Address
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Address Line | 17834 MIRANDA ST
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City | ENCINO
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State | CA
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Zip | 91316-1115
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Country | US
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Telephone | 818-600-8193
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Fax | 818-600-8194
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BIENVENIDO TAN
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Credential | MD
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Telephone | 661-259-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A18536
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License Number State | CA
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