Provider Demographics
| NPI: | 1598728479 |
|---|---|
| Name: | MEDCESSITY INC. |
| Entity Type: | Organization |
| Organization Name: | MEDCESSITY INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | VP/OWNER |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | HANK |
| Authorized Official - Middle Name: | JONATHAN |
| Authorized Official - Last Name: | CHINN |
| Authorized Official - Suffix: | JR |
| Authorized Official - Credentials: | MPT |
| Authorized Official - Phone: | 562-428-3556 |
| Mailing Address - Street 1: | 4010 ORANGE AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LONG BEACH |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 90807-3717 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 562-428-3556 |
| Mailing Address - Fax: | 562-428-3621 |
| Practice Address - Street 1: | 4010 ORANGE AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | LONG BEACH |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 90807-2374 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 562-428-3556 |
| Practice Address - Fax: | 562-428-3621 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-04-10 |
| Last Update Date: | 2010-11-17 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| CA | 00978 | 225000000X, 225X00000X, 225XE1200X, 225XH1300X, 225XN1300X, 225XP0200X |
| CA | 23647 | 225100000X, 2251G0304X, 2251H1200X, 2251N0400X, 2251S0007X, 2251X0800X |
| CA | 978 | 225XH1200X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225000000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotic Fitter | Group - Multi-Specialty | |
| No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics | Group - Multi-Specialty |
| No | 2251H1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand | Group - Multi-Specialty |
| No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology | Group - Multi-Specialty |
| No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | Group - Multi-Specialty |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Multi-Specialty |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 225XE1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Ergonomics | Group - Multi-Specialty |
| No | 225XH1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | Group - Multi-Specialty |
| No | 225XH1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Human Factors | Group - Multi-Specialty |
| No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation | Group - Multi-Specialty |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CA | ZZZ08589Z | Other | BLUE SHIELD OF CALIFORNIA |
| CA | ZZZ08588Z | Other | BLUE SHIELD OF CALIFORNIA |
| CA | W17199 | Medicare UPIN | |
| CA | ZZZ08588Z | Other | BLUE SHIELD OF CALIFORNIA |
