Organization Name: | BRISTOL MCFADDEN MEDICAL GROUP,INC. |
NPI Number: | 1003902610 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KASIN EKMAHA CHAI (PRESIDENT) |
Mailing Address: | 1212 S Bristol St Suite 16 Santa Ana |
State: | CA US |
Postal Code: | 927043476 |
Phone Number: | 7149660646 |
Fax Number: | 7149662438 |
NPI Enumeration Date: | 10/04/2006 |
NPI Last Update Date: | 07/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |