Provider Demographics
NPI:1336699479
Name:PREMIUM MEDICAL CARE, PC
Entity Type:Organization
Organization Name:PREMIUM MEDICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YONGHONG
Authorized Official - Middle Name:
Authorized Official - Last Name:XIAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-961-8881
Mailing Address - Street 1:13203 SANFORD AVE STE 1C
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4310
Mailing Address - Country:US
Mailing Address - Phone:718-961-8881
Mailing Address - Fax:718-961-4333
Practice Address - Street 1:13203 SANFORD AVE STE 1C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4310
Practice Address - Country:US
Practice Address - Phone:718-961-8881
Practice Address - Fax:718-961-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center