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General NPI Number Information
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NPI Number | 1194111377
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Entity Type | Organization
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Legal Business Name | SENIOR FIRST IPA
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 6800 LINCOLN AVE, SUITE 200
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City | BUENA PARK
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State | CA
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Zip | 90620
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Country | US
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Telephone | 714-495-4392
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Fax | 714-388-3354
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Provider Business Mailing Address
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Address Line | 6800 LINCOLN AVE, SUITE 200
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City | BUENA PARK
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State | CA
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Zip | 90620
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Country | US
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Telephone | 714-495-4392
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Fax | 714-388-3354
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Authorized Official
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Title or Position | CEO
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Name | KELVIN MAI
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Credential | D.O.
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Telephone | 714-495-4392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | C3748755
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License Number State | CA
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