MEDICARE: CARDIN HEALTHCARE, A MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171W00000X	Contractor
2	207Q00000X	Family Medicine Physician
3	208000000X	Pediatrics Physician
4	261QM0850X	Adult Mental Health Clinic/Center
5	261QM0855X	Adolescent and Children Mental Health Clinic/Center
6	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1043640063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIN HEALTHCARE, A MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	2880 ATLANTIC AVE
Second Line	:	SUITE 170
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1714
Country	:	US
Telephone Number	:	562-492-9900
Fax Number	:	562-492-9902

Provider Business Practice Location Address
First Line	:	2880 ATLANTIC AVE STE 170
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1715
Country	:	US
Telephone Number	:	562-492-9900
Fax Number	:	562-492-9902

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JOHN PAUL CARDIN JR.
Credential	:	M.D.
Telephone Number	:	562-492-9900

Provider Enumeration Date	:	11/13/2013
Last Update Date	:	12/19/2024

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