| First Fountains Medical Center Inc | |
|
2707 E Valley Blvd Suite 103 West Covina CA 91792 | |
| (626) 810-7772 | |
| (626) 810-0304 |
| Full Name | First Fountains Medical Center Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2707 E Valley Blvd, West Covina, California |
| Authorized Official Name and Position | Ker-chow Chang (PRESIDENT) |
| Authorized Official Contact | 6268107772 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| First Fountains Medical Center Inc 2707 E Valley Blvd Suite 103 West Covina CA 91792-3140 Ph: (626) 810-7772 | First Fountains Medical Center Inc 2707 E Valley Blvd Suite 103 West Covina CA 91792 Ph: (626) 810-7772 |
| NPI Number | 1972697100 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 05/24/2018 |
| Medicare PECOS PAC ID | 6406800754 |
|---|---|
| Medicare Enrollment ID | O20050309000560 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972697100 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A48893 (California) | Primary |
| Provider Name | Ker Chow Chang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346333648 PECOS PAC ID: 9335030444 Enrollment ID: I20040319001641 |
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