NPIMap

Organization Active NPI

Grand OB-GYN Medical Group Inc

  • Gynecologic Oncology Physician
  • Montclair, CA
National Provider Identifier
1043571599
Registry record updated Jun 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
License
A37294 Issued in CA
Legal business name
GRAND OB-GYN MEDICAL GROUP INC
Practice address
4950 San Bernardino St
Sute 106
Montclair, CA 91763-2328
Phone
(909) 625-0615
Fax
(909) 621-6735
NPI assigned
May 31, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas Tuan Tong Lee, M.D.NPI 1942304373
Title
Medical Director
Phone
(909) 625-0615

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Reproductive Endocrinology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VE0102X A37294 CA
Maternal & Fetal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VM0101X
Gynecologic Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VX0201X A37294 CA Primary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X A37294 CA

Addresses

Primary practice location

4950 San Bernardino St
Sute 106
Montclair, CA 91763-2328

Mailing address

4950 San Bernardino St
Suite 106
Montclair, CA 91763-2328
Phone (909) 625-0615

Other identifiers 1

IdentifierTypeStateIssuer
1477763829MedicaidCA

National Provider Directory

National Provider Directory

Locations

703 E E St
Ontario, CA 91764
Phone (909) 435-4707

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338508800000",
    "number": "1043571599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4950 SAN BERNARDINO ST",
            "address_2": "SUITE 106",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632328",
            "telephone_number": "909-625-0615",
            "fax_number": "909-621-6735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4950 SAN BERNARDINO ST",
            "address_2": "SUTE 106",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632328",
            "telephone_number": "909-625-0615",
            "fax_number": "909-621-6735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND OB-GYN MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-31",
        "last_updated": "2012-06-01",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "TUAN TONG",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "909-625-0615",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207VE0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
            "state": "CA",
            "license": "A37294",
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "CA",
            "license": "A37294",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "A37294",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477763829",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montclair, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.