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General NPI Number Information
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NPI Number | 1922024736
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Entity Type | Organization
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Legal Business Name | SHALOM MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1175 N EUCLID ST
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City | ANAHEIM
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State | CA
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Zip | 92801-1938
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Country | US
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Telephone | 714-563-1997
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Fax |
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Provider Business Mailing Address
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Address Line | 1175 N EUCLID ST
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City | ANAHEIM
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State | CA
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Zip | 92801-1938
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Country | US
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Telephone | 714-563-1997
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | NATHAN CHUNG
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Credential |
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Telephone | 714-563-1997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A60371
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License Number State | CA
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