Provider Demographics
NPI:1386283042
Name:IN PHYSICIAN ASSOCIATES, A PROFESSIONAL MEDICAL CORPORTATION
Entity type:Organization
Organization Name:IN PHYSICIAN ASSOCIATES, A PROFESSIONAL MEDICAL CORPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONFIGURATION
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-579-0703
Mailing Address - Street 1:6119 E WASHINGTON BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-2452
Mailing Address - Country:US
Mailing Address - Phone:323-899-8283
Mailing Address - Fax:
Practice Address - Street 1:6119 E WASHINGTON BLVD STE 201
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2452
Practice Address - Country:US
Practice Address - Phone:323-899-8283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization