| 365 Medical Group, Inc | |
|
12865 Main St Ste 204 Garden Grove CA 92840-8200 | |
| (714) 360-0739 | |
| Not Available |
| Full Name | 365 Medical Group, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 12865 Main St Ste 204, Garden Grove, California |
| Authorized Official Name and Position | Tan Nguyen (OWNER) |
| Authorized Official Contact | 7143600739 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 365 Medical Group, Inc 12865 Main St Ste 204 Garden Grove CA 92840-8200 Ph: (714) 360-0739 | 365 Medical Group, Inc 12865 Main St Ste 204 Garden Grove CA 92840-8200 Ph: (714) 360-0739 |
| NPI Number | 1780275016 |
|---|---|
| Provider Enumeration Date | 01/29/2021 |
| Last Update Date | 01/29/2021 |
| Medicare PECOS PAC ID | 7810304516 |
|---|---|
| Medicare Enrollment ID | O20210324003296 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780275016 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Tan The Nguyen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609839299 PECOS PAC ID: 7810995362 Enrollment ID: I20081212000602 |
| Provider Name | Padmaja Gadadoss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952657702 PECOS PAC ID: 4284959891 Enrollment ID: I20150202000983 |
| Provider Name | Richard T Tran |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578883385 PECOS PAC ID: 9739499872 Enrollment ID: I20151102002418 |
| Provider Name | Dung Quoc Truong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205209285 PECOS PAC ID: 4688941958 Enrollment ID: I20170517002280 |
| Provider Name | Georgina Calderon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700437522 PECOS PAC ID: 2466884838 Enrollment ID: I20191125000259 |
| Provider Name | Kimoanh Thi Nguyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801556188 PECOS PAC ID: 8022401157 Enrollment ID: I20220211001876 |
| Provider Name | Mulika Y Tsi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902565716 PECOS PAC ID: 8325433592 Enrollment ID: I20220325000530 |
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