| Tantam Medical Group, Inc. | |
|
1610 W Edinger Ave Ste B Santa Ana CA 92704-4339 | |
| (714) 641-1610 | |
| (714) 641-1146 |
| Full Name | Tantam Medical Group, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 1610 W Edinger Ave Ste B, Santa Ana, California |
| Authorized Official Name and Position | Pumipak Tantamjarik (PHYSICIAN) |
| Authorized Official Contact | 7146411610 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tantam Medical Group, Inc. 1610 W Edinger Ave Ste B Santa Ana CA 92704-4339 Ph: (714) 641-1610 | Tantam Medical Group, Inc. 1610 W Edinger Ave Ste B Santa Ana CA 92704-4339 Ph: (714) 641-1610 |
| NPI Number | 1154315828 |
|---|---|
| Provider Enumeration Date | 09/08/2005 |
| Last Update Date | 02/23/2023 |
| Medicare PECOS PAC ID | 6406894625 |
|---|---|
| Medicare Enrollment ID | O20050419000948 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154315828 | NPI | - | NPPES |
| GR0027840 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A71362 (California) | Primary |
| 208000000X | Pediatrics | A31595 (California) | Secondary |
| 208D00000X | General Practice | A31442 (California) | Secondary |
| Provider Name | Pumipak Tantamjarik |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891789566 PECOS PAC ID: 1759336951 Enrollment ID: I20050321001001 |
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