Basic Information
| Provider Information | |||||||||
| NPI: | 1215178520 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHWAYS MEDICAL GROUP, INC. | ||||||||
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| OtherOrganizationName: | HEALTHPOINT MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6518 GREENLEAF AVE., #25 | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626987161 | ||||||||
| FaxNumber: | 5626987276 | ||||||||
| Practice Location | |||||||||
| Address1: | 6518 GREENLEAF AVE., #25 | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626987161 | ||||||||
| FaxNumber: | 5626987276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2009 | ||||||||
| LastUpdateDate: | 07/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | CHUN | ||||||||
| AuthorizedOfficialFirstName: | SERENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5626987161 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.