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General NPI Number Information
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NPI Number | 1760921563
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Entity Type | Organization
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Legal Business Name | OPTIMAL HEALTH MEDICAL CENTER INC
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 2095 S ATLANTIC BLVD FL 2
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City | MONTEREY PARK
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State | CA
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Zip | 91754-6303
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Country | US
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Telephone | 626-965-9078
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Fax | 626-965-9076
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Provider Business Mailing Address
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Address Line | 2095 S. ATLANTIC BLVD., 2ND FLOOR
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City | MONTEREY PARK
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State | CA
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Zip | 91754
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Country | US
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Telephone | 626-965-9078
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Fax | 626-965-9076
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. HENRY KAN
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Credential | DC
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Telephone | 626-965-9078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC27615
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | A98528
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | A69120
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | C4858310
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License Number State | CA
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