MEDICARE: DEL MAR MEDICAL GROUP

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1528240595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEL MAR MEDICAL GROUP

Provider Business Mailing Address
First Line	:	415 W VALLEY BLVD
Second Line	:	C
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3728
Country	:	US
Telephone Number	:	626-943-9240
Fax Number	:	626-943-9242

Provider Business Practice Location Address
First Line	:	415 W VALLEY BLVD
Second Line	:	C
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3728
Country	:	US
Telephone Number	:	626-943-9240
Fax Number	:	626-943-9242

Authorized Official
Title or Position	:	OFFICER
Name	:	TAI HING WU
Credential	:	MD
Telephone Number	:	626-943-9240

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	12/01/2008

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Directions to “DEL MAR MEDICAL GROUP ” Practice Location

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