| Herman Sardjono Md Medical Corporat | |
|
72 W Las Tunas Dr Arcadia CA 91007 | |
| (626) 821-5305 | |
| (626) 821-0141 |
| Full Name | Herman Sardjono Md Medical Corporat |
|---|---|
| Speciality | Internal Medicine |
| Location | 72 W Las Tunas Dr, Arcadia, California |
| Authorized Official Name and Position | Herman Sardjono Md (PRESIDENT) |
| Authorized Official Contact | 6268215305 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Herman Sardjono Md Medical Corporat 72 W Las Tunas Dr Arcadia CA 91007 Ph: (626) 821-5305 | Herman Sardjono Md Medical Corporat 72 W Las Tunas Dr Arcadia CA 91007 Ph: (626) 821-5305 |
| NPI Number | 1700890167 |
|---|---|
| Provider Enumeration Date | 07/28/2006 |
| Last Update Date | 11/12/2019 |
| Medicare PECOS PAC ID | 3274429790 |
|---|---|
| Medicare Enrollment ID | O20040223000945 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700890167 | NPI | - | NPPES |
| 00A417930 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A41793 (California) | Primary |
| Provider Name | Herman Sardjono |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225142128 PECOS PAC ID: 6608762125 Enrollment ID: I20040224000460 |
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