Healthcare Provider Details

I. General information

NPI: 1477575314
Provider Name (Legal Business Name): ALLERGY ASTHMA CENTER OF THE CENTRAL VALLEY A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 E ALLUVIAL AVE 103
FRESNO CA
93720-3854
US

IV. Provider business mailing address

1855 E ALLUVIAL AVE 103
FRESNO CA
93720-3854
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-6700
  • Fax: 559-299-6766
Mailing address:
  • Phone: 559-299-6700
  • Fax: 559-299-6766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SIMHEAN LEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-299-6700