MEDICARE: PACIFIC ALLIANCE MEDICAL CENTER, INC

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

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	:	1972551174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC ALLIANCE MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	711 W COLLEGE ST
Second Line	:	628
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-1163
Country	:	US
Telephone Number	:	213-830-8920
Fax Number	:	213-830-8925

Provider Business Practice Location Address
First Line	:	4837 HUNTINGTON DR N
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-1953
Country	:	US
Telephone Number	:	323-343-9460
Fax Number	:	323-343-9466

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	DR. SHI-YIN WONG
Credential	:	M.D
Telephone Number	:	213-830-8950

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	06/11/2013

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