Provider Demographics
NPI:1003451386
Name:AKOS MD IPA LLC
Entity Type:Organization
Organization Name:AKOS MD IPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAN
Authorized Official - Middle Name:NHU BICH
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-399-8996
Mailing Address - Street 1:2391 CATHERINE RD
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2334
Mailing Address - Country:US
Mailing Address - Phone:818-399-8996
Mailing Address - Fax:866-627-3093
Practice Address - Street 1:20565 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3563
Practice Address - Country:US
Practice Address - Phone:818-399-8996
Practice Address - Fax:866-627-3093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE