Provider Demographics
NPI:1972524072
Name:BETHESDA HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:BETHESDA HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KE
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:626-307-2818
Mailing Address - Street 1:3333 SAN GABRIEL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2583
Mailing Address - Country:US
Mailing Address - Phone:626-307-2818
Mailing Address - Fax:626-307-2810
Practice Address - Street 1:3333 SAN GABRIEL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2583
Practice Address - Country:US
Practice Address - Phone:626-307-2818
Practice Address - Fax:626-307-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 26965111N00000X
CAAC 7639171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26965Medicare ID - Type Unspecified