Provider Demographics
NPI:1497914923
Name:GREATER PHILADELPHIA ASIAN SOCIAL SERVICE CENTER
Entity Type:Organization
Organization Name:GREATER PHILADELPHIA ASIAN SOCIAL SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EUNYOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-456-1662
Mailing Address - Street 1:4943 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-3809
Mailing Address - Country:US
Mailing Address - Phone:215-456-1662
Mailing Address - Fax:215-456-1664
Practice Address - Street 1:4943 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-3809
Practice Address - Country:US
Practice Address - Phone:215-456-1662
Practice Address - Fax:215-456-1664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA807367251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100730234 0003Medicaid
PA100730234 0002Medicaid