Provider Demographics
NPI:1245397512
Name:UNITED MEDCARE
Entity Type:Organization
Organization Name:UNITED MEDCARE
Other - Org Name:PHOENIX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FUNG-WAH
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-482-0644
Mailing Address - Street 1:1127 WILSHIRE BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3901
Mailing Address - Country:US
Mailing Address - Phone:213-482-0644
Mailing Address - Fax:213-482-0668
Practice Address - Street 1:1127 WILSHIRE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3903
Practice Address - Country:US
Practice Address - Phone:213-482-0644
Practice Address - Fax:213-482-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA554013336C0003X, 3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA443900Medicaid
2002618OtherPK
CAPHA221350Medicaid
0576352OtherNCPDP PROVIDER IDENTIFICATION NUMBER