Provider Demographics
NPI:1477575314
Name:ALLERGY ASTHMA CENTER OF THE CENTRAL VALLEY A MEDICAL CORP
Entity Type:Organization
Organization Name:ALLERGY ASTHMA CENTER OF THE CENTRAL VALLEY A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMHEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-299-6700
Mailing Address - Street 1:1855 E ALLUVIAL AVE
Mailing Address - Street 2:103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3854
Mailing Address - Country:US
Mailing Address - Phone:559-299-6700
Mailing Address - Fax:559-299-6766
Practice Address - Street 1:1855 E ALLUVIAL AVE
Practice Address - Street 2:103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3854
Practice Address - Country:US
Practice Address - Phone:559-299-6700
Practice Address - Fax:559-299-6766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ25286ZMedicare ID - Type Unspecified