MEDICARE: PACIFIC HEALTH EDUCATION CENTER

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1942813993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC HEALTH EDUCATION CENTER

Provider Business Mailing Address
First Line	:	5300 CALIFORNIA AVE STE 200
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-1642
Country	:	US
Telephone Number	:	661-633-5300
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 CALIFORNIA AVE STE 200
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-1642
Country	:	US
Telephone Number	:	661-633-5300
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	CHIN KIM
Credential	:
Telephone Number	:	909-533-7433

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	08/28/2020

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