Provider Demographics
NPI:1790908259
Name:KAMILA COMPREHENSIVE HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:KAMILA COMPREHENSIVE HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:TIEN-HOANG
Authorized Official - Middle Name:LU
Authorized Official - Last Name:MAI
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:562-806-7545
Mailing Address - Street 1:5831 FIRESTONE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-3718
Mailing Address - Country:US
Mailing Address - Phone:562-806-7545
Mailing Address - Fax:562-806-6062
Practice Address - Street 1:5831 FIRESTONE BLVD STE E
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-3718
Practice Address - Country:US
Practice Address - Phone:562-806-7545
Practice Address - Fax:562-806-6062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18238363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty