Healthcare Provider Details

I. General information

NPI: 1679911895
Provider Name (Legal Business Name): HANKOOK IPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2654 W LA PALMA AVE
ANAHEIM CA
92801-2601
US

IV. Provider business mailing address

2654 W LA PALMA AVE
ANAHEIM CA
92801-2601
US

V. Phone/Fax

Practice location:
  • Phone: 714-827-0700
  • Fax:
Mailing address:
  • Phone: 714-827-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: PAUL CHANG
Title or Position: CEO
Credential: M.D.
Phone: 626-656-2370