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General NPI Number Information
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NPI Number | 1750564043
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Entity Type | Organization
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Legal Business Name | AWESOME BLESSINGS MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 595 ESTUDILLO AVE
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4611
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Country | US
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Telephone | 510-483-5881
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Fax | 510-483-7114
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Provider Business Mailing Address
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Address Line | 595 ESTUDILLO AVE
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4611
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Country | US
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Telephone | 510-483-5881
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Fax | 510-483-7114
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Authorized Official
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Title or Position | OWNER
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Name | DR. THAN AYE AW
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Credential | M.D
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Telephone | 559-905-9087
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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 | A53206
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | A53206
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | A53206
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License Number State | CA
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