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General NPI Number Information
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NPI Number | 1023549086
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Entity Type | Organization
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Legal Business Name | PREMIUM MEDICAL CARE INC
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 926 ARCH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1852
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Country | US
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Telephone | 267-496-9873
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Fax |
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Provider Business Mailing Address
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Address Line | 926 ARCH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1852
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Country | US
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Telephone | 267-496-9873
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Fax |
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Authorized Official
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Title or Position | MD, PHD
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Name | HUIKAI TIAN
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Credential | MD
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Telephone | 215-459-7701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD455256
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License Number State | PA
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