Provider Demographics
NPI:1164582466
Name:EDMUND B FOO M D INC
Entity Type:Organization
Organization Name:EDMUND B FOO M D INC
Other - Org Name:EDMUND B FOO M.D. INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:BONG LING
Authorized Official - Last Name:FOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-913-2383
Mailing Address - Street 1:1850 S AZUSA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6813
Mailing Address - Country:US
Mailing Address - Phone:626-913-2383
Mailing Address - Fax:626-913-2013
Practice Address - Street 1:1850 S AZUSA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6813
Practice Address - Country:US
Practice Address - Phone:626-913-2383
Practice Address - Fax:626-913-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-10
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
CAC40019261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty