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INTERNATIONAL PEDIATRIC MEDICAL GROUP INC NPI 1861591752


NPI Information

NPI: 1861591752
Provider Name: INTERNATIONAL PEDIATRIC MEDICAL GROUP INC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 05D0990908

Address:
600 INTERNATIONAL BLVD
#102
OAKLAND, CA
ZIP 94606
Phone: (510) 208-3540
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INTERNATIONAL PEDIATRIC MEDICAL GROUP INC is a pediatrics in Oakland, CA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. INTERNATIONAL PEDIATRIC MEDICAL GROUP INC NPI is 1861591752. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

600 INTERNATIONAL BLVD
#102
OAKLAND, CA
ZIP 94606
Phone: (510) 208-3540
Fax: (510) 208-3553

The provider's authorized official is An Tan Pham .
The authorized official title is Md and has the following contact phone number (510) 208-3540.

The CLIA number assigned to this NPI record is 05D0990908 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/21/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsA67904CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
100A679040OTHERCALIFORNIAMEDI CAL

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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