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1777 N Bellflower Blvd Ste 102 Long Beach CA 90815-4019 | |
| (562) 512-6475 | |
| (562) 512-9012 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1777 N Bellflower Blvd Ste 102, Long Beach, California |
| Authorized Official Name and Position | Medard Sison (OWNER) |
| Authorized Official Contact | 5625126475 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3711 Long Beach Blvd Unit 4535 Long Beach CA 90807-3315 Ph: (562) 512-6475 | 1777 N Bellflower Blvd Ste 102 Long Beach CA 90815-4019 Ph: (562) 512-6475 |
| NPI Number | 1134986995 |
|---|---|
| Provider Enumeration Date | 02/28/2024 |
| Last Update Date | 03/29/2024 |
| Certification Date | 03/29/2024 |
| Medicare PECOS PAC ID | 7012450455 |
|---|---|
| Medicare Enrollment ID | O20240613003464 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134986995 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Jason P Kellogg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952331530 PECOS PAC ID: 5597789123 Enrollment ID: I20060120000873 |
| Provider Name | Linda H Trinh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124333828 PECOS PAC ID: 0547498834 Enrollment ID: I20140113001084 |
| Provider Name | Phuong Tran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275990111 PECOS PAC ID: 4981900297 Enrollment ID: I20160314000930 |
| Provider Name | Medard Sison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922507037 PECOS PAC ID: 8820352057 Enrollment ID: I20180515002925 |
| Provider Name | Kelsey Joan Pearson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770365306 PECOS PAC ID: 9436592920 Enrollment ID: I20240212004053 |
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