MEDICARE: 1CHINOMED INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	36D0351113	CA

General Provider Information

NPI Number	:	1891009825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1CHINOMED INC

Provider Business Mailing Address
First Line	:	11490 BURBANK BLVD
Second Line	:	STE 1D
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-2389
Country	:	US
Telephone Number	:	888-881-6367
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E STATE ST
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45701-1856
Country	:	US
Telephone Number	:	888-881-6367
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTOPHER FRALEY
Credential	:	M.D.
Telephone Number	:	888-881-6367

Provider Enumeration Date	:	08/02/2010
Last Update Date	:	08/02/2010

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