Organization
J1 MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHUTOC C TRANDINH MD (PRESIDENT)
(541) 471-0120
Entity
Organization
Contact information
Practice address
124 NW MIDLAND AVE, SUITE 110, GRANTS PASS, OR 97526-1269
(541) 471-0120
(541) 471-0118
Mailing address
PO BOX 2196, GRANTS PASS, OR 97528-0276
(541) 471-0120
(541) 471-0118
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD24478
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227321
—
OR
Enumeration date
07/14/2006
Last updated
08/22/2020
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