Provider Demographics
NPI:1528144920
Name:ASIAN NETWORK HOSPICE
Entity type:Organization
Organization Name:ASIAN NETWORK HOSPICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:IVY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KWONG
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT,MPA
Authorized Official - Phone:510-268-1118
Mailing Address - Street 1:212 9TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4428
Mailing Address - Country:US
Mailing Address - Phone:510-268-1118
Mailing Address - Fax:510-268-9905
Practice Address - Street 1:212 9TH ST STE 204
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4428
Practice Address - Country:US
Practice Address - Phone:510-268-1118
Practice Address - Fax:510-268-9905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000628251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01749FMedicaid
CA051749Medicare ID - Type UnspecifiedHOSPICE