Healthcare Provider Details

I. General information

NPI: 1124205182
Provider Name (Legal Business Name): NORTH EAST MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 NORIEGA ST
SAN FRANCISCO CA
94122-4432
US

IV. Provider business mailing address

1520 STOCKTON STREET
SAN FRANCISCO CA
94133-3354
US

V. Phone/Fax

Practice location:
  • Phone: 415-391-9686
  • Fax: 415-352-5098
Mailing address:
  • Phone: 415-391-9686
  • Fax: 415-433-4726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number550000007
License Number StateCA

VIII. Authorized Official

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