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General NPI Number Information
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NPI Number | 1043304025
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Entity Type | Organization
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Legal Business Name | FIRST FOUNTAINS MEDICAL CENTER INC.
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 1480 S HARBOR BLVD STE 1
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City | LA HABRA
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State | CA
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Zip | 90631-7506
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Country | US
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Telephone | 714-255-1148
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Fax | 714-482-0778
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Provider Business Mailing Address
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Address Line | 1480 S HARBOR BLVD STE 1
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City | LA HABRA
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State | CA
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Zip | 90631-7506
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Country | US
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Telephone | 714-255-1148
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Fax | 714-482-0778
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KER-CHOW CHANG
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Credential | M.D.
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Telephone | 714-255-1148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A48893
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License Number State | CA
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