MEDICARE: HEALTHY MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A52914	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154422715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	1045 E VALLEY BLVD
Second Line	:	SUITE A210
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3664
Country	:	US
Telephone Number	:	626-572-0012
Fax Number	:	626-572-0799

Provider Business Practice Location Address
First Line	:	1045 E VALLEY BLVD
Second Line	:	SUITE A210
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3664
Country	:	US
Telephone Number	:	626-572-0012
Fax Number	:	626-572-0799

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	STEPHEN S LEUNG
Credential	:	M.D
Telephone Number	:	626-572-0012

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	08/04/2022

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