=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922993815
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDWELL CLINIC PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2025
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7695 WESTMINSTER BLVD
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-3921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-383-0661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7695 WESTMINSTER BLVD
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-3921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-872-8071
-----------------------------------------------------
Fax | 714-872-8702
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/CFO
-----------------------------------------------------
Name | TRANG MINH VU
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 714-383-0661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207QS0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------