Provider Demographics
NPI:1093956849
Name:PATIENT CARE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:PATIENT CARE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BOSHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:QIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-458-2489
Mailing Address - Street 1:PO BOX 7230
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91802-7230
Mailing Address - Country:US
Mailing Address - Phone:626-607-9406
Mailing Address - Fax:626-458-2489
Practice Address - Street 1:320 S GARFIELD AVE STE 206
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-6815
Practice Address - Country:US
Practice Address - Phone:626-607-9406
Practice Address - Fax:626-458-2489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-07
Last Update Date:2009-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83150207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA83150OtherCALIFORNIA MEDICAL LICENSE