1841406436 NPI number — SILVER WISDOM ADULT DAY HEALTHCARE CENTER, INC.

Table of content: DR. SONG CHERNG WANG MA (NPI 1811022999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841406436 NPI number — SILVER WISDOM ADULT DAY HEALTHCARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SILVER WISDOM ADULT DAY HEALTHCARE CENTER, 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:
1841406436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1714 IVAR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90028-5124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-464-9161
Provider Business Mailing Address Fax Number:
323-464-9166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1714 IVAR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90028-5124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-464-9161
Provider Business Practice Location Address Fax Number:
323-464-9166
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OHANIAN
Authorized Official First Name:
HOVHANNES
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
323-464-9161

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ADU70314F . This is a "MEDI-CAL PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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