Healthcare Provider Details

I. General information

NPI: 1831449222
Provider Name (Legal Business Name): APCN-ACO, A MEDICAL PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 HUNTINGTON DRIVE #201 C/O MSO, INC. OF SOUTHERN CALIFORNIA
SAN MARINO CA
91108
US

IV. Provider business mailing address

2360 HUNTINGTON DRIVE #201 C/O MSO, INC. OF SOUTHERN CALIFORNIA
SAN MARINO CA
91108
US

V. Phone/Fax

Practice location:
  • Phone: 818-399-8996
  • Fax:
Mailing address:
  • Phone: 818-399-8996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. EN MING LAI
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 626-319-3089