Healthcare Provider Details

I. General information

NPI: 1427424654
Provider Name (Legal Business Name): CHINATOWN SERVICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S ATLANTIC BLVD STE 303
MONTEREY PARK CA
91754-6712
US

IV. Provider business mailing address

767 N HILL ST STE 400
LOS ANGELES CA
90012-2381
US

V. Phone/Fax

Practice location:
  • Phone: 626-773-3385
  • Fax:
Mailing address:
  • Phone: 213-808-1792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number960000220
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: EDWARD LEW
Title or Position: CHIEF DENTIST
Credential: DMD
Phone: 213-808-1790