| NPI | 1003451386 |
|---|---|
| Other Name | N/A |
| Entity Type | Organization |
| Authorized Contact | LAN NHU BICH PHAN Administrator 818-399-8996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2019-11-11 |
| Last Update Date | 2019-11-11 |