Provider Demographics
NPI:1033803796
Name:WYNK'S CLINIC
Entity Type:Organization
Organization Name:WYNK'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-347-1182
Mailing Address - Street 1:1788 S SAN GABRIEL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3978
Mailing Address - Country:US
Mailing Address - Phone:626-656-6253
Mailing Address - Fax:626-573-8643
Practice Address - Street 1:1788 S SAN GABRIEL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3978
Practice Address - Country:US
Practice Address - Phone:626-656-6253
Practice Address - Fax:626-573-8643
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WYNK'S CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health