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Organization
123 MEDICAL GROUP CORP.
Active
Organization
123 MEDICAL GROUP CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALLAN C CHANG LAC, DOM, DAOM (PRESIDENT)
(626) 889-6917
Entity
Organization
Contact information
Practice address
18800 AMAR RD STE C12, WALNUT, CA 91789-4561
(626) 788-9691
(626) 608-0318
Mailing address
18800 AMAR RD STE C12, WALNUT, CA 91789-4561
(626) 788-9691
(626) 608-0318
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1588029771
FAMILY MEDICINE
—
Enumeration date
12/15/2015
Last updated
08/09/2022
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