1770655847 NPI number — ALPHA CARE MEDICAL GROUP, INC

Table of content: (NPI 1770655847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770655847 NPI number — ALPHA CARE MEDICAL GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPHA CARE MEDICAL GROUP, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770655847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1668 S. GARFIELD AVENUE, 2ND FLOOR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALHAMBRA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-943-6228
Provider Business Mailing Address Fax Number:
626-943-6343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2589 E. WASHINGTON BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-798-8792
Provider Business Practice Location Address Fax Number:
626-401-1671
Provider Enumeration Date:
11/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAM
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
626-943-6228

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)