Healthcare Provider Details

I. General information

NPI: 1407490931
Provider Name (Legal Business Name): NORTH EAST MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 OCEAN AVE
SAN FRANCISCO CA
94112-1731
US

IV. Provider business mailing address

2171 JUNIPERO SERRA BLVD STE 700
DALY CITY CA
94014-1982
US

V. Phone/Fax

Practice location:
  • Phone: 415-391-9686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: EDDIE W CHAN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 415-391-9686