Provider Demographics
NPI:1609887280
Name:HONG SHENG MEDICINE LLC
Entity Type:Organization
Organization Name:HONG SHENG MEDICINE LLC
Other - Org Name:NORTHEAST CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:CHEN-AN
Authorized Official - Middle Name:
Authorized Official - Last Name:HSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-222-0181
Mailing Address - Street 1:3309 N EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-1931
Mailing Address - Country:US
Mailing Address - Phone:323-222-0181
Mailing Address - Fax:323-222-2733
Practice Address - Street 1:3309 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1931
Practice Address - Country:US
Practice Address - Phone:323-222-0181
Practice Address - Fax:323-222-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556453336C0003X
CAPHY462663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100106063Medicaid
0524771OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA159040Medicaid
CAPHA462660Medicaid