Provider Demographics
NPI:1376958942
Name:ADVANCED PREMIER PHYSICIANS ACO
Entity Type:Organization
Organization Name:ADVANCED PREMIER PHYSICIANS ACO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:KWANSEUNG
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-234-5575
Mailing Address - Street 1:17215 STUDEBAKER RD STE 331
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2557
Mailing Address - Country:US
Mailing Address - Phone:714-705-4598
Mailing Address - Fax:
Practice Address - Street 1:17215 STUDEBAKER RD STE 331
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2557
Practice Address - Country:US
Practice Address - Phone:714-705-4598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization