Provider Demographics
NPI:1467766691
Name:THE SAN PEDRO CLINIC
Entity Type:Organization
Organization Name:THE SAN PEDRO CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SUH
Authorized Official - Middle Name:CHEN
Authorized Official - Last Name:HSIAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-832-7545
Mailing Address - Street 1:704 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3017
Mailing Address - Country:US
Mailing Address - Phone:310-832-7545
Mailing Address - Fax:310-833-8580
Practice Address - Street 1:704 W 8TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3017
Practice Address - Country:US
Practice Address - Phone:310-832-7545
Practice Address - Fax:310-833-8580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service