Healthcare Provider Details

I. General information

NPI: 1679643068
Provider Name (Legal Business Name): CENTRAL HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 PARK VIEW DR SUITE 120
COVINA CA
91724-3700
US

IV. Provider business mailing address

1051 PARK VIEW DR SUITE 120
COVINA CA
91724-3700
US

V. Phone/Fax

Practice location:
  • Phone: 626-388-2300
  • Fax: 626-388-2317
Mailing address:
  • Phone: 626-388-2300
  • Fax: 626-388-2317

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: MR. KEVIN W KIRBY
Title or Position: INFORMATION SYSTEMS DIRECTOR
Credential:
Phone: 626-388-2300