Provider Demographics
NPI:1407075948
Name:KA WOO MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:KA WOO MEDICAL CLINIC INC
Other - Org Name:NORA TEE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-282-3657
Mailing Address - Street 1:841 W VALLEY BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3251
Mailing Address - Country:US
Mailing Address - Phone:626-282-3657
Mailing Address - Fax:626-282-2759
Practice Address - Street 1:841 W VALLEY BLVD STE 107
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3251
Practice Address - Country:US
Practice Address - Phone:626-282-3657
Practice Address - Fax:626-282-2759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A532013Medicaid
CA00A532013Medicaid
CAF90101Medicare UPIN