Provider Demographics
NPI:1154474591
Name:ORIENTAL FAMILY MEDICINE CHARTERED
Entity Type:Organization
Organization Name:ORIENTAL FAMILY MEDICINE CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HONGJIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HE
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:727-442-9220
Mailing Address - Street 1:901 N HERCULES AVE
Mailing Address - Street 2:SUITE F.
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-2031
Mailing Address - Country:US
Mailing Address - Phone:727-442-9220
Mailing Address - Fax:727-445-9799
Practice Address - Street 1:901 N HERCULES AVE
Practice Address - Street 2:SUITE F.
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2031
Practice Address - Country:US
Practice Address - Phone:727-442-9220
Practice Address - Fax:727-445-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP00028171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC00064OtherBLUE CROSS