Provider Demographics
NPI:1548324429
Name:FIRST SANTA ANA MEDICAL GROUP INC
Entity type:Organization
Organization Name:FIRST SANTA ANA MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NGO
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-547-3915
Mailing Address - Street 1:2337 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-3503
Mailing Address - Country:US
Mailing Address - Phone:714-547-2915
Mailing Address - Fax:714-547-4968
Practice Address - Street 1:2337 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3503
Practice Address - Country:US
Practice Address - Phone:714-547-2915
Practice Address - Fax:714-547-4968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0001140Medicaid
CAA26121Medicare UPIN
CAWA30475AMedicare ID - Type Unspecified