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NPI Code Detail

MEDICARE: TED MEDICAL GROUP, INC.

MEDICARE: TED 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
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1497396451
Entity Type Code : Organization
Provider Name (Legal Business Name) : TED MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : 12865 MAIN ST STE 105
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92840-8205
Country : US
Telephone Number : 800-560-9999
Fax Number : 800-391-4191
Provider Business Practice Location Address
First Line : 12865 MAIN ST STE 105
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92840-8205
Country : US
Telephone Number : 800-560-9999
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : EMILY NGUYEN
Credential :
Telephone Number : 800-560-9999
Provider Enumeration Date : 10/01/2019
Last Update Date : 10/01/2019

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