Provider Demographics
NPI:1013934082
Name:ABC MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:ABC MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:YE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-288-4840
Mailing Address - Street 1:500 N GARFIELD AVE
Mailing Address - Street 2:SUITE 110A
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1242
Mailing Address - Country:US
Mailing Address - Phone:626-282-4840
Mailing Address - Fax:626-288-4820
Practice Address - Street 1:500 N GARFIELD AVE
Practice Address - Street 2:SUITE 110A
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1242
Practice Address - Country:US
Practice Address - Phone:626-282-4840
Practice Address - Fax:626-288-4820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63361207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A633640Medicaid
CAW15313Medicare ID - Type Unspecified
CA00A633640Medicaid