MEDICARE: ASIAN AMERICAN DRUG ABUSE PROGRAM, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3245S0500X	Children's Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1477161149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASIAN AMERICAN DRUG ABUSE PROGRAM, INC

Provider Business Mailing Address
First Line	:	2900 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4265
Country	:	US
Telephone Number	:	323-596-2310
Fax Number	:

Provider Business Practice Location Address
First Line	:	4625 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-1209
Country	:	US
Telephone Number	:	323-596-2310
Fax Number	:	323-596-2317

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	JOSE ESQUEDA
Credential	:
Telephone Number	:	323-596-2310

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	07/20/2020

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