| NPI | 1417672569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN PHAM CEO 424-622-5437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2022-10-11 |
| Last Update Date | 2023-04-06 |