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General NPI Number Information
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NPI Number | 1992861058
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Entity Type | Organization
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Legal Business Name | JOHNTIN MEDICAL GROUP
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Dates
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Enumeration Date | 12/30/2006
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 1722 DESIRE AVE STE 202
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748-2970
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Country | US
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Telephone | 626-913-1888
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Fax | 626-913-1999
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Provider Business Mailing Address
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Address Line | 1722 DESIRE AVE STE 202
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748-2970
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Country | US
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Telephone | 626-913-1888
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Fax | 626-913-1999
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. TIN YAU YUNG
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Credential | M.D.
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Telephone | 626-913-1888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | G61730
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License Number State | CA
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