Healthcare Provider Details

I. General information

NPI: 1538470695
Provider Name (Legal Business Name): CENTER FOR PAN ASIAN COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6185 BUFORD HWY BLDG B
PEACHTREE CORNERS GA
30071-2350
US

IV. Provider business mailing address

6185 BUFORD HWY BLDG B
PEACHTREE CORNERS GA
30071-2350
US

V. Phone/Fax

Practice location:
  • Phone: 770-446-0929
  • Fax: 770-446-6977
Mailing address:
  • Phone: 770-446-0929
  • Fax: 770-446-6977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHAIWON KIM
Title or Position: CEO
Credential: RN
Phone: 770-936-0969