Provider Demographics
NPI:1689026700
Name:EXCELLENT HEALTHCARE MANAGEMENT INC
Entity Type:Organization
Organization Name:EXCELLENT HEALTHCARE MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:YUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-307-0550
Mailing Address - Street 1:1788 S SAN GABRIEL BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3978
Mailing Address - Country:US
Mailing Address - Phone:626-307-0550
Mailing Address - Fax:626-307-1892
Practice Address - Street 1:1788 S SAN GABRIEL BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3978
Practice Address - Country:US
Practice Address - Phone:626-307-0550
Practice Address - Fax:626-307-1892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61730302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17115Medicare UPIN