Provider Demographics
NPI:1568805802
Name:PACIFIC ALLIANCE MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:PACIFIC ALLIANCE MEDICAL CENTER, INC
Other - Org Name:PACIFIC ALLIANCE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:SHI-YIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-830-8950
Mailing Address - Street 1:711 W COLLEGE ST
Mailing Address - Street 2:SUITE 628
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-1163
Mailing Address - Country:US
Mailing Address - Phone:213-830-8950
Mailing Address - Fax:213-617-9203
Practice Address - Street 1:711 W COLLEGE ST
Practice Address - Street 2:SUITE#428
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1163
Practice Address - Country:US
Practice Address - Phone:213-437-4216
Practice Address - Fax:213-617-7213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty