MEDICARE: SYNGO LLC

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	315P00000X	Intellectual Disabilities Intermediate Care Facility		CA

General Provider Information

NPI Number	:	1710266218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNGO LLC

Provider Business Mailing Address
First Line	:	421 S ROCK RIVER RD
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-1562
Country	:	US
Telephone Number	:	818-481-7818
Fax Number	:	909-599-0701

Provider Business Practice Location Address
First Line	:	1342 PASEO ENCINAS
Second Line	:
City	:	SAN DIMAS
State	:	CA
Zip	:	91773-4217
Country	:	US
Telephone Number	:	909-599-0701
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN CHOU
Credential	:
Telephone Number	:	818-481-7818

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	08/15/2011

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Directions to “SYNGO LLC ” Practice Location

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