MEDICARE: SENTINEL 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1295297570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENTINEL MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	505 N TUSTIN AVE STE 195
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3775
Country	:	US
Telephone Number	:	866-786-7816
Fax Number	:	866-786-7806

Provider Business Practice Location Address
First Line	:	505 N TUSTIN AVE STE 195
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3775
Country	:	US
Telephone Number	:	866-786-7816
Fax Number	:	866-786-7806

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAXWELL YUI CHUN JEN
Credential	:	MD
Telephone Number	:	909-964-9472

Provider Enumeration Date	:	04/04/2019
Last Update Date	:	04/30/2019

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