Organization
CENTER FOR PRIMARY CARE MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT TAE HA MD (PRESIDENT)
(714) 847-6727
Entity
Organization
Contact information
Practice address
8700 WARNER AVE, SUITE 140, FOUNTAIN VALLEY, CA 92708-3207
(714) 847-6727
(714) 847-6643
Mailing address
8700 WARNER AVE, SUITE 140, FOUNTAIN VALLEY, CA 92708-3207
(714) 847-6727
(714) 847-6643
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A055299
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A552992
BLUE SHIELD
CA
Enumeration date
11/19/2007
Last updated
11/22/2013
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