Healthcare Provider Details

I. General information

NPI: 1770655847
Provider Name (Legal Business Name): ALPHA CARE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2589 E. WASHINGTON BLVD.
PASADENA CA
91107
US

IV. Provider business mailing address

1668 S. GARFIELD AVENUE, 2ND FLOOR
ALHAMBRA CA
91801
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-8792
  • Fax: 626-401-1671
Mailing address:
  • Phone: 626-943-6228
  • Fax: 626-943-6343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS LAM
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.D., M.P.H.
Phone: 626-943-6228