Provider Demographics
NPI:1740299833
Name:GARVEY HEALTHY FAMILY MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:GARVEY HEALTHY FAMILY MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUNG
Authorized Official - Middle Name:MAUNG
Authorized Official - Last Name:OO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-312-5488
Mailing Address - Street 1:705 E GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-3024
Mailing Address - Country:US
Mailing Address - Phone:626-312-5488
Mailing Address - Fax:626-312-5455
Practice Address - Street 1:705 E GARVEY AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755-3024
Practice Address - Country:US
Practice Address - Phone:626-312-5488
Practice Address - Fax:626-312-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA052220207R00000X
CAA54127208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A522200Medicaid
CA00A522200Medicaid
A52220AMedicare UPIN