1982787206 NPI number — LINCOLN HEIGHTS FAMILY AND INDUSTRIAL MEDICAL CLINIC

Table of content: (NPI 1982787206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982787206 NPI number — LINCOLN HEIGHTS FAMILY AND INDUSTRIAL MEDICAL CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINCOLN HEIGHTS FAMILY AND INDUSTRIAL MEDICAL CLINIC
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:
WEST COAST MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1982787206
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:
1501 E HOLT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POMONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91767-5823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-623-3600
Provider Business Mailing Address Fax Number:
909-623-3383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 E HOLT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91767-5823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-623-3600
Provider Business Practice Location Address Fax Number:
909-623-3383
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHUNG
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
KWOK-KUEN
Authorized Official Title or Position:
PRESIDENT-OWNER
Authorized Official Telephone Number:
909-623-3600

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  A37294 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208000000X , with the licence number: A50856 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208D00000X , with the licence number: A33894 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363A00000X , with the licence number: PA 14845 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363A00000X , with the licence number: PA 16663 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363A00000X , with the licence number: PA 17061 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LX0001X , with the licence number: RN 548298 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: WPA16663A . This is a "PETER LE PPIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0056501 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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