Organization
BRISTOL MCFADDEN MEDICAL GROUP,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KASIN EKMAHA CHAI M.D. (PRESIDENT)
(714) 966-0646
Entity
Organization
Contact information
Practice address
1212 S BRISTOL ST, SUITE 16, SANTA ANA, CA 92704-3476
(714) 966-0646
(714) 966-2438
Mailing address
1212 S BRISTOL ST, SUITE 16, SANTA ANA, CA 92704-3476
(714) 966-0646
(714) 966-2438
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0009850
—
CA
Enumeration date
10/04/2006
Last updated
07/23/2013
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