Provider Demographics
NPI:1154422715
Name:HEALTHY MEDICAL GROUP INC
Entity type:Organization
Organization Name:HEALTHY MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-572-0012
Mailing Address - Street 1:1045 E VALLEY BLVD
Mailing Address - Street 2:SUITE A210
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3664
Mailing Address - Country:US
Mailing Address - Phone:626-572-0012
Mailing Address - Fax:626-572-0799
Practice Address - Street 1:1045 E VALLEY BLVD
Practice Address - Street 2:SUITE A210
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3664
Practice Address - Country:US
Practice Address - Phone:626-572-0012
Practice Address - Fax:626-572-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A529140Medicaid
F77394Medicare UPIN
CA00A529140Medicaid