Provider Demographics
NPI:1891266904
Name:EVERGREEN INTERNATIONAL GROUP, LLC
Entity Type:Organization
Organization Name:EVERGREEN INTERNATIONAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:JENQ HORNG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-889-9929
Mailing Address - Street 1:1937 PONTIUS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5611
Mailing Address - Country:US
Mailing Address - Phone:310-889-9929
Mailing Address - Fax:310-889-9939
Practice Address - Street 1:1937 PONTIUS AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5611
Practice Address - Country:US
Practice Address - Phone:310-889-9929
Practice Address - Fax:310-889-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies