| NPI | 1578017778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAN NHU BICH PHAN CEO 818-399-8996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: CA A) |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2022-07-21 |