Provider Demographics
NPI:1457795346
Name:ACUMEDI HEALTH CLINICS
Entity Type:Organization
Organization Name:ACUMEDI HEALTH CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SANG JAE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:213-505-1071
Mailing Address - Street 1:19821 ITASCA ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-5607
Mailing Address - Country:US
Mailing Address - Phone:213-505-1071
Mailing Address - Fax:
Practice Address - Street 1:19821 ITASCA ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-5607
Practice Address - Country:US
Practice Address - Phone:213-505-1071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACUMEDI HEALTH CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14516302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization