Look up the most recent NPI and PECOS records

Md24 San Diego, Inc.

Family Medicine

Allopathic & Osteopathic Physicians

600 Anton Blvd Ste 1100, Costa Mesa, CA 92626-7100

PECOS Enrollment

Based on the most recent information from CMS, provider Md24 San Diego, Inc. does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 11:51 AM.

Profile Details

Provider ID
1053898395
Provider Type
Organization
Full Name
Md24 San Diego, Inc.

Subpart
No
Enumeration Date
7/19/2018
Last Updated
7/19/2018

Contact Information

Practice Location

600 Anton Blvd Ste 1100, Costa Mesa, CA 92626-7100

(623) 374-7774

Unlisted Fax

Mailing Location

14780 W Mountain View Blvd Ste 110, Surprise, AZ 85374-7280

(623) 374-7774

Unlisted Fax

Authorized Official

Nguyen, Linh C (Ceo)

(623) 374-7774

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License Unlisted Issuer

Md24 San Diego, Inc.

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

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Chau, Sara Tran Hong

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Kao, Michael

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Shaw, Pravin

Phan, Thao Minh

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