Provider Demographics
NPI:1346341328
Name:GOLDEN PACIFIC NEPHROLOGY MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:GOLDEN PACIFIC NEPHROLOGY MEDICAL CLINIC, INC.
Other - Org Name:PACIFIC NEPHROLOGY MEDICAL GROUP, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HSIN-HUI
Authorized Official - Middle Name:
Authorized Official - Last Name:HWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-280-0676
Mailing Address - Street 1:120 E EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-1709
Mailing Address - Country:US
Mailing Address - Phone:626-280-0676
Mailing Address - Fax:626-280-2694
Practice Address - Street 1:120 E EMERSON AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755-1709
Practice Address - Country:US
Practice Address - Phone:626-280-0676
Practice Address - Fax:626-280-2694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16325Medicare ID - Type Unspecified