Provider Demographics
NPI:1427424654
Name:CHINATOWN SERVICE CENTER
Entity type:Organization
Organization Name:CHINATOWN SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:213-808-1790
Mailing Address - Street 1:767 N HILL ST STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2381
Mailing Address - Country:US
Mailing Address - Phone:213-808-1792
Mailing Address - Fax:
Practice Address - Street 1:850 S ATLANTIC BLVD STE 303
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6712
Practice Address - Country:US
Practice Address - Phone:626-773-3385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA960000220261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty