Healthcare Provider Details

I. General information

NPI: 1639193303
Provider Name (Legal Business Name): KHEMARA FAMILY MEDICAL CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 ALAMITOS AVE
LONG BEACH CA
90813-2214
US

IV. Provider business mailing address

1533 ALAMITOS AVE
LONG BEACH CA
90813-2214
US

V. Phone/Fax

Practice location:
  • Phone: 562-218-5350
  • Fax: 562-218-1630
Mailing address:
  • Phone: 562-218-5350
  • Fax: 562-218-1630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC28687
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA41589
License Number StateCA

VIII. Authorized Official

Name: DR. NAGASAMUDRA S ASHOK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-218-5350