Provider Demographics
NPI:1043304025
Name:FIRST FOUNTAINS MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:FIRST FOUNTAINS MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KER-CHOW
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-255-1148
Mailing Address - Street 1:1480 S HARBOR BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-7506
Mailing Address - Country:US
Mailing Address - Phone:714-255-1148
Mailing Address - Fax:714-482-0778
Practice Address - Street 1:1480 S HARBOR BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-7506
Practice Address - Country:US
Practice Address - Phone:714-255-1148
Practice Address - Fax:714-482-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18518AMedicare ID - Type Unspecified
CAC33952Medicare UPIN