Provider Demographics
NPI:1992861058
Name:JOHNTIN MEDICAL GROUP
Entity type:Organization
Organization Name:JOHNTIN MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIN
Authorized Official - Middle Name:YAU
Authorized Official - Last Name:YUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-913-1888
Mailing Address - Street 1:1722 DESIRE AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2970
Mailing Address - Country:US
Mailing Address - Phone:626-913-1888
Mailing Address - Fax:626-913-1999
Practice Address - Street 1:1722 DESIRE AVE STE 202
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2970
Practice Address - Country:US
Practice Address - Phone:626-913-1888
Practice Address - Fax:626-913-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61730302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE21638Medicare UPIN