# BROAD MEDICAL GROUP INC.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255997763
- **Authorized official:** JENNIFER LAUREN BROAD MD (CEO/PRESIDENT)
- **Authorized official phone:** (949) 720-9848

## Contact information

- **Practice address:** 1640 NEWPORT BLVD STE 300, COSTA MESA, CA 92627-7725
- **Practice address phone:** (949) 720-9848
- **Practice address fax:** (949) 720-9195
- **Mailing address:** 1640 NEWPORT BLVD STE 300, COSTA MESA, CA 92627-7725
- **Mailing address phone:** (929) 720-9848
- **Mailing address fax:** (949) 720-9195

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/10/2019
- **Last updated:** 09/06/2025