| Shady Canyon Medical Group | |
|
16300 Sand Canyon Ave Suite 901 Irvine CA 92618-3711 | |
| (951) 375-8958 | |
| (949) 453-8601 |
| Full Name | Shady Canyon Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 16300 Sand Canyon Ave, Irvine, California |
| Authorized Official Name and Position | Albert Beomjin Chang (CEO) |
| Authorized Official Contact | 9513758958 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shady Canyon Medical Group 16300 Sand Canyon Ave Suite 901 Irvine CA 92618-3711 Ph: (951) 375-8958 | Shady Canyon Medical Group 16300 Sand Canyon Ave Suite 901 Irvine CA 92618-3711 Ph: (951) 375-8958 |
| NPI Number | 1922245349 |
|---|---|
| Provider Enumeration Date | 01/08/2009 |
| Last Update Date | 01/08/2009 |
| Medicare PECOS PAC ID | 7416083019 |
|---|---|
| Medicare Enrollment ID | O20100408000188 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922245349 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A77997 (California) | Primary |
| Provider Name | Albert B Chang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790755569 PECOS PAC ID: 0840292181 Enrollment ID: I20070215000260 |
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