Provider Demographics
NPI:1336493311
Name:CENTER FOR PAN ASIAN COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:CENTER FOR PAN ASIAN COMMUNITY SERVICES, INC.
Other - Org Name:CPACS-COSMO HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHAIWON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-936-0969
Mailing Address - Street 1:3510 SHALLOWFORD RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2909
Mailing Address - Country:US
Mailing Address - Phone:770-936-0969
Mailing Address - Fax:
Practice Address - Street 1:6185 BUFORD HWY BLDG B
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30071-2350
Practice Address - Country:US
Practice Address - Phone:770-936-0969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)