| Innovate Behavioral Health Medical Group Inc | |
|
732 N Mountain Ave Ste A Upland CA 91786-4372 | |
| (909) 579-2555 | |
| (909) 579-2118 |
| Full Name | Innovate Behavioral Health Medical Group Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 732 N Mountain Ave Ste A, Upland, California |
| Authorized Official Name and Position | Henry Htewlay Khin (OWNER) |
| Authorized Official Contact | 9095792555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovate Behavioral Health Medical Group Inc 732 N Mountain Ave Ste A Upland CA 91786-4372 Ph: () - | Innovate Behavioral Health Medical Group Inc 732 N Mountain Ave Ste A Upland CA 91786-4372 Ph: (909) 579-2555 |
| NPI Number | 1972129948 |
|---|---|
| Provider Enumeration Date | 06/24/2020 |
| Last Update Date | 02/17/2023 |
| Certification Date | 02/16/2023 |
| Medicare PECOS PAC ID | 8921491184 |
|---|---|
| Medicare Enrollment ID | O20220210001374 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972129948 | NPI | - | NPPES |
| Provider Name | Henry H Khin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871639682 PECOS PAC ID: 6002729076 Enrollment ID: I20031106000689 |
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