| Excell Integrated Medical Group Inc | |
|
14023 Paramount Blvd Paramount CA 90723-2605 | |
| (562) 331-8881 | |
| (562) 988-3373 |
| Full Name | Excell Integrated Medical Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 14023 Paramount Blvd, Paramount, California |
| Authorized Official Name and Position | Felicia Ponder (ADMINISTRATOR) |
| Authorized Official Contact | 9513151265 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Excell Integrated Medical Group Inc 14023 Paramount Blvd Paramount CA 90723-2605 Ph: (562) 331-8881 | Excell Integrated Medical Group Inc 14023 Paramount Blvd Paramount CA 90723-2605 Ph: (562) 331-8881 |
| NPI Number | 1659909521 |
|---|---|
| Provider Enumeration Date | 03/27/2020 |
| Last Update Date | 04/27/2020 |
| Medicare PECOS PAC ID | 1557782349 |
|---|---|
| Medicare Enrollment ID | O20200603001204 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659909521 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Samer Moghaddam |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1275700478 PECOS PAC ID: 7618193749 Enrollment ID: I20140728000206 |
| Provider Name | Vu D Tran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720424286 PECOS PAC ID: 8729371166 Enrollment ID: I20160722002091 |
| Provider Name | Michael K Cao |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649638628 PECOS PAC ID: 6406133073 Enrollment ID: I20170509000569 |
| Provider Name | Phuc Bao H Tran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811347198 PECOS PAC ID: 7719242262 Enrollment ID: I20180604001093 |
| Provider Name | Mohammad A Shahshahan |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1588018402 PECOS PAC ID: 8729323456 Enrollment ID: I20181227000237 |
| Provider Name | Joey Wong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699126730 PECOS PAC ID: 4981940145 Enrollment ID: I20190108003373 |
| Provider Name | Audrey Kohar Shu Yuan |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1356756118 PECOS PAC ID: 1557649845 Enrollment ID: I20190114000674 |
| Provider Name | Calvin T Doan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205364569 PECOS PAC ID: 0143567412 Enrollment ID: I20190124000482 |
| Provider Name | Richard Thai |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1407388291 PECOS PAC ID: 6901148931 Enrollment ID: I20191125002894 |
| Provider Name | Meshylle S Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518466432 PECOS PAC ID: 9638509003 Enrollment ID: I20200427000944 |
| Provider Name | Jennifer Ty De Guzman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790304194 PECOS PAC ID: 6002724515 Enrollment ID: I20200617001387 |
| Provider Name | Jason Wiguna |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346731767 PECOS PAC ID: 6507289485 Enrollment ID: I20200710001373 |
| Provider Name | Janice Z Lau |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1548623150 PECOS PAC ID: 6002100526 Enrollment ID: I20200828001508 |
| Provider Name | Kendra A Rickard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457948341 PECOS PAC ID: 7517374358 Enrollment ID: I20210324000277 |
| Provider Name | Zeeshan M Siddiqui |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699328567 PECOS PAC ID: 2365862000 Enrollment ID: I20210628002754 |
| Provider Name | Jakob Michael Francis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760035489 PECOS PAC ID: 4284054776 Enrollment ID: I20210903001734 |
| Provider Name | Kristoffer Tolentino Chin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790342764 PECOS PAC ID: 4981099769 Enrollment ID: I20220314000645 |
| Provider Name | Timothy M Goco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982223251 PECOS PAC ID: 4981099736 Enrollment ID: I20220315001384 |
| Provider Name | Daniel H Kwon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639736846 PECOS PAC ID: 9830573088 Enrollment ID: I20221104002221 |
| Provider Name | Howard C Pyo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831540632 PECOS PAC ID: 0840610036 Enrollment ID: I20221228002397 |
| Provider Name | Serena Tharani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568035715 PECOS PAC ID: 2466816889 Enrollment ID: I20230918002809 |
| Provider Name | Thuylien Chau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063104248 PECOS PAC ID: 8921462284 Enrollment ID: I20230919004047 |
| Provider Name | Thien-kim N Co |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1033732953 PECOS PAC ID: 4688029317 Enrollment ID: I20231016001259 |
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