| Organization Name: | BRISTOL MCFADDEN MEDICAL GROUP, INC. |
| NPI Number: | 1376843771 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KASIN EKMAHA CHAI (PRESIDENT OF CORPORATION) |
| Mailing Address: | 1226 E Mcfadden Ave Santa Ana |
| State: | CA US |
| Postal Code: | 927054106 |
| Phone Number: | 7142450288 |
| Fax Number: | 7142450488 |
| NPI Enumeration Date: | 11/01/2010 |
| 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: | |