Provider Demographics
NPI:1295802643
Name:ENG MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:ENG MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-289-8260
Mailing Address - Street 1:850 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4769
Mailing Address - Country:US
Mailing Address - Phone:626-289-8260
Mailing Address - Fax:626-289-4242
Practice Address - Street 1:850 S ATLANTIC BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4769
Practice Address - Country:US
Practice Address - Phone:626-289-8260
Practice Address - Fax:626-289-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55239207W00000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0048690Medicaid
W10963AMedicare ID - Type Unspecified