Provider Demographics
NPI:1215150529
Name:JOSHUA INTERNATIONAL MEDICAL GROUP
Entity type:Organization
Organization Name:JOSHUA INTERNATIONAL MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN. ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JINNI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-527-8943
Mailing Address - Street 1:7872 WALKER STREET
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623
Mailing Address - Country:US
Mailing Address - Phone:714-527-8777
Mailing Address - Fax:714-527-8990
Practice Address - Street 1:7872 WALKER STREET
Practice Address - Street 2:SUITE 211
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623
Practice Address - Country:US
Practice Address - Phone:714-527-8777
Practice Address - Fax:714-527-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0061200Medicaid
CAGR0061190Medicaid
CAGR0061200Medicaid
CAW12122AMedicare ID - Type UnspecifiedMEDICARE