Healthcare Provider Details

I. General information

NPI: 1629759550
Provider Name (Legal Business Name): MIDWEST ASIAN HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W 26TH ST
CHICAGO IL
60616-2204
US

IV. Provider business mailing address

218 W 26TH ST
CHICAGO IL
60616-2204
US

V. Phone/Fax

Practice location:
  • Phone: 312-285-2287
  • Fax: 312-225-8798
Mailing address:
  • Phone: 312-285-2287
  • Fax: 312-225-8798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JIA YIN WEE
Title or Position: MENTAL HEALTH CLINICAL MANAGER
Credential: LCPC
Phone: 312-285-2287