Provider Demographics
NPI:1932920055
Name:FAMILY TREE HEALTH.INC
Entity type:Organization
Organization Name:FAMILY TREE HEALTH.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIN
Authorized Official - Middle Name:HEE
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:909-903-0102
Mailing Address - Street 1:20627 GOLDEN SPRINGS DR STE 1J
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4815
Mailing Address - Country:US
Mailing Address - Phone:909-903-0102
Mailing Address - Fax:
Practice Address - Street 1:20627 GOLDEN SPRINGS DR STE 1J
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91789-4815
Practice Address - Country:US
Practice Address - Phone:909-903-0102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center