1124248570 NPI number — HEALTH ALLIANCE MEDICAL GROUP

Table of content: (NPI 1124248570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124248570 NPI number — HEALTH ALLIANCE MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH ALLIANCE MEDICAL GROUP
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:
1124248570
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1850 S. AZUSA AVE
Provider Second Line Business Mailing Address:
STE#60
Provider Business Mailing Address City Name:
HACIENDA HEIGHTS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91745-6827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-810-0706
Provider Business Mailing Address Fax Number:
626-946-9893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 S. AZUSA AVE
Provider Second Line Business Practice Location Address:
STE#60
Provider Business Practice Location Address City Name:
HACIENDA HEIGHTS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91745-6827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-810-0706
Provider Business Practice Location Address Fax Number:
626-946-9893
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HONE
Authorized Official First Name:
CHONG
Authorized Official Middle Name:
SAN
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
626-810-0706

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , 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: W11601 . This is a "GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0050620 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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