Organization
GRAND OB-GYN MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS TUAN TONG LEE M.D. (MEDICAL DIRECTOR)
(909) 625-0615
Entity
Organization
Contact information
Practice address
4950 SAN BERNARDINO ST, SUTE 106, MONTCLAIR, CA 91763-2328
(909) 625-0615
(909) 621-6735
Mailing address
4950 SAN BERNARDINO ST, SUITE 106, MONTCLAIR, CA 91763-2328
(909) 625-0615
(909) 621-6735
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
A37294
CA
207VM0101X
Maternal & Fetal Medicine Physician
—
—
207VX0201X
Gynecologic Oncology Physician
Primary
A37294
CA
208600000X
Surgery Physician
A37294
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477763829
—
CA
Enumeration date
05/31/2012
Last updated
06/01/2012
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