MEDICARE: NORTH EAST MEDICAL SERVICES

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	1223G0001X	General Practice Dentistry
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1821779364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH EAST MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	2171 JUNIPERO SERRA BLVD STE 700
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94014-1982
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 TARAVAL ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-2346
Country	:	US
Telephone Number	:	415-391-9686
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	EDDIE W CHAN
Credential	:
Telephone Number	:	415-391-9686

Provider Enumeration Date	:	07/27/2023
Last Update Date	:	07/27/2023

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Directions to “NORTH EAST MEDICAL SERVICES ” Practice Location

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