Healthcare Provider Details

I. General information

NPI: 1588286603
Provider Name (Legal Business Name): TRI HEALTH MEDICAL INSTITUTE MANAGEMENT COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17777 VENTURA BLVD STE 100
ENCINO CA
91316-3738
US

IV. Provider business mailing address

90 VANTIS DR UNIT 3062
ALISO VIEJO CA
92656-2516
US

V. Phone/Fax

Practice location:
  • Phone: 844-366-6898
  • Fax: 844-578-6558
Mailing address:
  • Phone: 949-307-0412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOUAN CHEN
Title or Position: MEDICAL BILLER
Credential:
Phone: 949-307-0412