Provider Demographics
NPI:1922993815
Name:MEDWELL CLINIC, PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MEDWELL CLINIC, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRANG
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:714-383-0661
Mailing Address - Street 1:7695 WESTMINSTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3921
Mailing Address - Country:US
Mailing Address - Phone:714-383-0661
Mailing Address - Fax:
Practice Address - Street 1:7695 WESTMINSTER BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3921
Practice Address - Country:US
Practice Address - Phone:714-383-0661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty