Provider Demographics
NPI:1831449222
Name:APCN-ACO, A MEDICAL PROFESSIONAL CORP
Entity type:Organization
Organization Name:APCN-ACO, A MEDICAL PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EN
Authorized Official - Middle Name:MING
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-319-3089
Mailing Address - Street 1:2360 HUNTINGTON DRIVE #201
Mailing Address - Street 2:C/O MSO, INC. OF SOUTHERN CALIFORNIA
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108
Mailing Address - Country:US
Mailing Address - Phone:818-399-8996
Mailing Address - Fax:
Practice Address - Street 1:2360 HUNTINGTON DRIVE #201
Practice Address - Street 2:C/O MSO, INC. OF SOUTHERN CALIFORNIA
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108
Practice Address - Country:US
Practice Address - Phone:818-399-8996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization