MEDICARE: MIDWEST ASIAN HEALTH ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	251B00000X	Case Management Agency
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1629759550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST ASIAN HEALTH ASSOCIATION

Provider Business Mailing Address
First Line	:	218 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2204
Country	:	US
Telephone Number	:	312-285-2287
Fax Number	:	312-225-8798

Provider Business Practice Location Address
First Line	:	218 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2204
Country	:	US
Telephone Number	:	312-285-2287
Fax Number	:	312-225-8798

Authorized Official
Title or Position	:	MENTAL HEALTH CLINICAL MANAGER
Name	:	JIA YIN WEE
Credential	:	LCPC
Telephone Number	:	312-285-2287

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	07/25/2023

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