MEDICARE: LINCOLN HEIGHTS FAMILY AND INDUSTRIAL MEDICAL CLINIC

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	207Q00000X	Family Medicine Physician	A53847	CA
2	207VX0000X	Obstetrics Physician	A35695	CA
3	208000000X	Pediatrics Physician	A53847	CA
4	208D00000X	General Practice Physician	A33894	CA
5	363A00000X	Physician Assistant	PA 13853	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942309497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINCOLN HEIGHTS FAMILY AND INDUSTRIAL MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	2409 N BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-2218
Country	:	US
Telephone Number	:	323-225-8038
Fax Number	:	323-225-2106

Provider Business Practice Location Address
First Line	:	2409 N BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-2218
Country	:	US
Telephone Number	:	323-225-8038
Fax Number	:	323-225-2106

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KELLY HONG VO
Credential	:
Telephone Number	:	323-225-8038

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	09/11/2025

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