Provider Demographics
NPI:1053335406
Name:AURORA MEDICAL CORPORATION
Entity Type:Organization
Organization Name:AURORA MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YONG
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-579-9541
Mailing Address - Street 1:11245 LOWER AZUSA RD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1411
Mailing Address - Country:US
Mailing Address - Phone:626-579-9541
Mailing Address - Fax:626-579-9604
Practice Address - Street 1:11245 LOWER AZUSA RD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1411
Practice Address - Country:US
Practice Address - Phone:626-579-9541
Practice Address - Fax:626-579-9604
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AURORA MEDICAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56523261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A565230Medicaid
CA00A565230Medicaid