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	261QF0400X	Federally Qualified Health Center (FQHC)		CA

General Provider Information

NPI Number	:	1881825305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH EAST MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	1520 STOCKTON ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-3354
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2574 SAN BRUNO AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94134-1505
Country	:	US
Telephone Number	:	415-391-9686
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MR. EDDIE CHAN
Credential	:	PHARM.D.
Telephone Number	:	415-391-9686

Provider Enumeration Date	:	07/31/2009
Last Update Date	:	02/17/2010

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Directions to “NORTH EAST MEDICAL SERVICES ” Practice Location

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