1831400795 NPI number — STRONGKIDS MEDICAL GROUP INC

Table of content: (NPI 1831400795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831400795 NPI number — STRONGKIDS MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRONGKIDS MEDICAL GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831400795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92658-8500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-542-1331
Provider Business Mailing Address Fax Number:
714-542-4758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2222 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92707-3220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-542-1331
Provider Business Practice Location Address Fax Number:
714-542-4758
Provider Enumeration Date:
06/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SWEIDAN
Authorized Official First Name:
JACOB
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO/OWNER
Authorized Official Telephone Number:
714-915-4656

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  A44664 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: A35731 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1265521843 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1265494835 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1457368227 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861796609 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1417179318 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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