Healthcare Provider Details

I. General information

NPI: 1134482326
Provider Name (Legal Business Name): CHINATOWN SERVICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S GARFIELD AVE SUITE 118
ALHAMBRA CA
91801-3886
US

IV. Provider business mailing address

767 N HILL ST SUITE 400
LOS ANGELES CA
90012-2343
US

V. Phone/Fax

Practice location:
  • Phone: 626-773-3388
  • Fax: 626-773-3389
Mailing address:
  • Phone: 213-808-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number550001510
License Number StateCA

VIII. Authorized Official

Name: JACK CHENG
Title or Position: CHIEF OPERATING OFFICER
Credential: JD, CHC, CHPC
Phone: 213-808-1709