Prodigy Medical Service Inc

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

PRODIGY MEDICAL SERVICE INC

Practice address

406 9TH Ave Ste 307
San Diego, CA 92101-7278

Phone

(619) 630-0125

NPI assigned

Apr 10, 2023

Organization subpart

No

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

Authorized official

Name

Leon Yan, MDNPI 1962569228

Title

Owner

Phone

(951) 249-1755

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Leon Yan, MD

  • Pediatrics Physician
  • Murrieta, CA
  • NPI 1962569228
  NPD Authorized official

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

{
    "created_epoch": "1681084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681084800000",
    "number": "1295420743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29995 TECHNOLOGY DR UNIT A100",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925632632",
            "telephone_number": "951-249-2755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 9TH AVE STE 307",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921017278",
            "telephone_number": "619-630-0125"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "29995 Technology Dr Unit A100",
            "address_purpose": "LOCATION",
            "city": "Murrieta",
            "state": "CA",
            "postal_code": "925632632",
            "country_code": "US",
            "telephone_number": "951-412-1610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRODIGY MEDICAL SERVICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-10",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A",
        "authorized_official_last_name": "YAN",
        "authorized_official_first_name": "LEON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-249-1755",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bradley Wayne Proctor, IDC
• Christopher Proctor
• Jacob Anderson Proctor, SFIDC
• Laura J Proctor, PHD
• Nicole Jolene Proctor, MSW
• Professional and Personal Excellence International
• Professional Imaging Services, Inc.
• Professional Management Services, Inc
• Professional Speech & Counseling Services Inc.
• Professional Surgicenter, Inc

• Health Service Clinic/Center in San Diego, CA
• Providers in San Diego, CA by specialty
• Health Service Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; 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.