| K Phun Medical Clinic Inc | |
|
2418 San Gabriel Blvd Rosemead CA 91770-3674 | |
| (626) 288-7321 | |
| (626) 571-5275 |
| Full Name | K Phun Medical Clinic Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2418 San Gabriel Blvd, Rosemead, California |
| Authorized Official Name and Position | Kenneth Phun (PRESIDENT) |
| Authorized Official Contact | 6262887321 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| K Phun Medical Clinic Inc 2418 San Gabriel Blvd Rosemead CA 91770-3674 Ph: (626) 288-7321 | K Phun Medical Clinic Inc 2418 San Gabriel Blvd Rosemead CA 91770-3674 Ph: (626) 288-7321 |
| NPI Number | 1558018200 |
|---|---|
| Provider Enumeration Date | 03/02/2022 |
| Last Update Date | 03/02/2022 |
| Certification Date | 03/02/2022 |
| Medicare PECOS PAC ID | 4789070061 |
|---|---|
| Medicare Enrollment ID | O20220413002808 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558018200 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kenneth Phun |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801837927 PECOS PAC ID: 5597711481 Enrollment ID: I20050323001195 |
| Provider Name | Marvin Hoang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558083121 PECOS PAC ID: 0840666715 Enrollment ID: I20221018000766 |
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