MEDICARE: MIDWEST ASIAN HEALTH ASSOCIATION

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1679211825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST ASIAN HEALTH ASSOCIATION

Provider Business Mailing Address
First Line	:	218 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2204
Country	:	US
Telephone Number	:	312-285-2287
Fax Number	:	312-225-8798

Provider Business Practice Location Address
First Line	:	218 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2204
Country	:	US
Telephone Number	:	312-285-2287
Fax Number	:	312-225-8798

Authorized Official
Title or Position	:	CLINICAL MANAGER
Name	:	JIA YIN WEE
Credential	:
Telephone Number	:	312-285-2287

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	03/07/2024

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