| Peppertree Multispecialty Medical Group, Inc. | |
|
3220 S Brea Canyon Rd Ste H Diamond Bar CA 91765-3481 | |
| (909) 594-1848 | |
| (909) 594-7959 |
| Full Name | Peppertree Multispecialty Medical Group, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 3220 S Brea Canyon Rd Ste H, Diamond Bar, California |
| Authorized Official Name and Position | Beau Michael Chung (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9492748807 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peppertree Multispecialty Medical Group, Inc. 3220 Brea Canyon Rd., Ste H Diamond Bar CA 91765-3339 Ph: (909) 594-1848 | Peppertree Multispecialty Medical Group, Inc. 3220 S Brea Canyon Rd Ste H Diamond Bar CA 91765-3481 Ph: (909) 594-1848 |
| NPI Number | 1740303924 |
|---|---|
| Provider Enumeration Date | 04/10/2007 |
| Last Update Date | 07/11/2019 |
| Medicare PECOS PAC ID | 7214079417 |
|---|---|
| Medicare Enrollment ID | O20100127000159 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740303924 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G36420 (California) | Primary |
| Provider Name | Michael Kwok |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881717197 PECOS PAC ID: 3779713052 Enrollment ID: I20140306001122 |
| Provider Name | Beau Michael Chung |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1841746799 PECOS PAC ID: 3072842939 Enrollment ID: I20190918001580 |
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