Organization Active NPI

Leduc Medical Group, Inc.

  • Gastroenterology Physician
  • Fountain Valley, CA
National Provider Identifier
1073692406
Registry record updated Aug 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
LEDUC MEDICAL GROUP, INC.
Practice address
11160 Warner Ave
Suite 101
Fountain Valley, CA 92708-4010
Phone
(714) 540-0105
Fax
(714) 540-6727
NPI assigned
Nov 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2013

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

Authorized official

Name
Stuart Chung
Title
Administrator
Phone
(714) 540-0105

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X Primary
Clinical Genetics (M.D.) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207SG0201X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

11160 Warner Ave
Suite 101
Fountain Valley, CA 92708-4010

Mailing address

11160 Warner Ave
Suite 101
Fountain Valley, CA 92708-4010
Phone (714) 540-0105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120207000457 CA Part B Supplier - Clinic/Group Practice 0244497071 Receives reassigned benefits from 1 practitioner
Practice locations: Fountain Valley, CA

National Provider Directory

National Provider Directory

Locations

11160 Warner Ave
Ste 201
Fountain Vly, CA 92708
Phone (714) 540-0105

11160 Warner Ave
Ste 101
Fountain Vly, CA 92708
Phone (714) 540-0105

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": "1162684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375747200000",
    "number": "1073692406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11160 WARNER AVE",
            "address_2": "SUITE 101",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084010",
            "telephone_number": "714-540-0105",
            "fax_number": "714-540-6727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11160 WARNER AVE",
            "address_2": "SUITE 101",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084010",
            "telephone_number": "714-540-0105",
            "fax_number": "714-540-6727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEDUC MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-05",
        "last_updated": "2013-08-06",
        "status": "A",
        "authorized_official_last_name": "CHUNG",
        "authorized_official_first_name": "STUART",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "714-540-0105"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207SG0201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.