Healthcare Provider Details

I. General information

NPI: 1043218134
Provider Name (Legal Business Name): ON LOK SENIOR HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 BUSH ST
SAN FRANCISCO CA
94109-5611
US

IV. Provider business mailing address

1333 BUSH ST
SAN FRANCISCO CA
94109-5611
US

V. Phone/Fax

Practice location:
  • Phone: 415-292-8888
  • Fax: 415-292-8745
Mailing address:
  • Phone: 415-292-8888
  • Fax: 415-292-8745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number9330385
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: GRACE LI HARPER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 415-292-8883