Provider Demographics
NPI:1285114157
Name:HASTINGS RANCH PHYSICIANS GROUP, INC.
Entity type:Organization
Organization Name:HASTINGS RANCH PHYSICIANS GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:I-LUN
Authorized Official - Last Name:JENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:818-396-5737
Mailing Address - Street 1:1113 FOOTHILL BLVD
Mailing Address - Street 2:#A
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011
Mailing Address - Country:US
Mailing Address - Phone:818-369-7848
Mailing Address - Fax:818-671-3521
Practice Address - Street 1:1113 FOOTHILL BLVD
Practice Address - Street 2:#A
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011
Practice Address - Country:US
Practice Address - Phone:818-369-7848
Practice Address - Fax:818-671-3521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA106414OtherPHYSICIAN LICENSE
CA1003053851OtherNPI
CA1164831293OtherNPI