=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508897752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARCADIA PRIMARY CARE PHYSICIANS MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 11/28/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1505 S BALDWIN AVE # B
-----------------------------------------------------
City | ARCADIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91007-7925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-445-1556
-----------------------------------------------------
Fax | 626-574-9059
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1505 S BALDWIN AVE # B
-----------------------------------------------------
City | ARCADIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91007-7925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-445-1556
-----------------------------------------------------
Fax | 626-574-9059
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. GLENN MICHAEL HO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 626-445-1556
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A38922
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------