Full Name | |
---|---|
Speciality | Clinic/center |
Location | 56480 Highway 371, Anza, California |
Authorized Official Name and Position | Jonathan Yujung Yun (PRESIDENT) |
Authorized Official Contact | 9515955589 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
56480 Highway 371 P.o. Box 391313 Anza CA 92539 Ph: (951) 763-2626 | 56480 Highway 371 Anza CA 92539 Ph: (951) 763-2626 |
NPI Number | 1942485610 |
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Provider Enumeration Date | 12/31/2007 |
Last Update Date | 01/06/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942485610 | NPI | - | NPPES |
00AX87590 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 20A8759 (California) | Primary |
Anza Community Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 56480 Highway 371, Anza, CA 92539 Phone: 951-694-8549 Fax: 951-694-0249 | |