=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861297830
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHINATOWN SERVICE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2025
-----------------------------------------------------
Last Update Date | 02/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 833 S ATLANTIC BLVD SUITE E
-----------------------------------------------------
City | MONTEREY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-609-3399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 711 W COLLEGE ST STE 388
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90012-3177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-988-8131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC OPERATIONS MANAGER
-----------------------------------------------------
Name | ANGELA CHING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-808-1792
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------