Healthcare Provider Details

I. General information

NPI: 1740299833
Provider Name (Legal Business Name): GARVEY HEALTHY FAMILY MEDICAL CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E GARVEY AVE
MONTEREY PARK CA
91755-3024
US

IV. Provider business mailing address

705 E GARVEY AVE
MONTEREY PARK CA
91755-3024
US

V. Phone/Fax

Practice location:
  • Phone: 626-312-5488
  • Fax: 626-312-5455
Mailing address:
  • Phone: 626-312-5488
  • Fax: 626-312-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA54127
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA052220
License Number StateCA

VIII. Authorized Official

Name: DR. MAUNG MAUNG OO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-312-5488