Provider Demographics
NPI:1174649719
Name:ACCUMED CORPORATION
Entity Type:Organization
Organization Name:ACCUMED CORPORATION
Other - Org Name:ACCUMED MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BONG JA
Authorized Official - Middle Name:BENA
Authorized Official - Last Name:WON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHD
Authorized Official - Phone:818-508-6888
Mailing Address - Street 1:11239 VENTURA BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3167
Mailing Address - Country:US
Mailing Address - Phone:818-508-6888
Mailing Address - Fax:
Practice Address - Street 1:11239 VENTURA BLVD STE 214
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3167
Practice Address - Country:US
Practice Address - Phone:818-508-6888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP328052251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18329Medicare ID - Type UnspecifiedGROUP NUMBER
CAA90392Medicare UPIN