| Cerritos Medical Center, Inc | |
|
11911 Artesia Blvd Ste 101 Cerritos CA 90701-4065 | |
| (562) 402-7622 | |
| (562) 402-2452 |
| Full Name | Cerritos Medical Center, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 11911 Artesia Blvd, Cerritos, California |
| Authorized Official Name and Position | John Shin Kim (OWNER) |
| Authorized Official Contact | 5624027622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cerritos Medical Center, Inc 11911 Artesia Blvd Ste 101 Cerritos CA 90701-4065 Ph: (562) 402-7622 | Cerritos Medical Center, Inc 11911 Artesia Blvd Ste 101 Cerritos CA 90701-4065 Ph: (562) 402-7622 |
| NPI Number | 1871768663 |
|---|---|
| Provider Enumeration Date | 04/23/2008 |
| Last Update Date | 04/23/2008 |
| Medicare PECOS PAC ID | 1052469848 |
|---|---|
| Medicare Enrollment ID | O20090505000439 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871768663 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G66684 (California) | Primary |
| Provider Name | John Shin Kim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003991159 PECOS PAC ID: 2961569793 Enrollment ID: I20090505000265 |
| Provider Name | Teresa J Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386078327 PECOS PAC ID: 0648547109 Enrollment ID: I20170605001230 |
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