=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487195160
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW DAWN CHRISTIAN FAMILY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2017
-----------------------------------------------------
Last Update Date | 03/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2550 W MAIN ST SUITE 202
-----------------------------------------------------
City | ALHAMBRA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91801-1694
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-457-2900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2550 W MAIN ST SUITE 202
-----------------------------------------------------
City | ALHAMBRA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91801-1694
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-457-2900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. DANIEL L JEUNG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-457-2900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 34461
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------