MEDICARE: KHEMARA FAMILY MEDICAL CLINIC 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	111N00000X	Chiropractor	DC28687	CA
2	207R00000X	Internal Medicine Physician	A41589	CA

General Provider Information

NPI Number	:	1639193303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KHEMARA FAMILY MEDICAL CLINIC INC.

Provider Business Mailing Address
First Line	:	1533 ALAMITOS AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-2214
Country	:	US
Telephone Number	:	562-218-5350
Fax Number	:	562-218-1630

Provider Business Practice Location Address
First Line	:	1533 ALAMITOS AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-2214
Country	:	US
Telephone Number	:	562-218-5350
Fax Number	:	562-218-1630

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NAGASAMUDRA S ASHOK
Credential	:	M.D.
Telephone Number	:	562-218-5350

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	02/23/2010

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