Provider Demographics
NPI:1972139103
Name:ACCESS INNOVATIVE HEALTH
Entity Type:Organization
Organization Name:ACCESS INNOVATIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-488-0692
Mailing Address - Street 1:336 1/2 S GLENDORA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3060
Mailing Address - Country:US
Mailing Address - Phone:626-814-0111
Mailing Address - Fax:
Practice Address - Street 1:336 1/2 S GLENDORA AVE STE C
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3060
Practice Address - Country:US
Practice Address - Phone:626-814-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service