Provider Demographics
NPI:1700211703
Name:YEHOWA MEDICAL SERVICES
Entity Type:Organization
Organization Name:YEHOWA MEDICAL SERVICES
Other - Org Name:VERMONT COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TWEH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:323-776-1500
Mailing Address - Street 1:24404 VERMONT AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2321
Mailing Address - Country:US
Mailing Address - Phone:323-776-1500
Mailing Address - Fax:855-777-2289
Practice Address - Street 1:11502 S VERMONT AVE STE C
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-6522
Practice Address - Country:US
Practice Address - Phone:323-776-1050
Practice Address - Fax:855-777-2289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center