Provider Demographics
NPI:1720112170
Name:ENG MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:ENG MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-796-7006
Mailing Address - Street 1:10 CONGRESS ST
Mailing Address - Street 2:STE 408
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3045
Mailing Address - Country:US
Mailing Address - Phone:626-796-7006
Mailing Address - Fax:626-796-9990
Practice Address - Street 1:10 CONGRESS ST
Practice Address - Street 2:STE 408
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3045
Practice Address - Country:US
Practice Address - Phone:626-796-7006
Practice Address - Fax:626-796-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55239332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1211090001Medicare NSC