Basic Information
| Provider Information | |||||||||
| NPI: | 1407889637 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE CARDIOVASCULAR SPECIALISTS, A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 S 1ST ST | ||||||||
| Address2: | |||||||||
| City: | ALHAMBRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 918013705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262818663 | ||||||||
| FaxNumber: | 6262816318 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 S 1ST ST | ||||||||
| Address2: | |||||||||
| City: | ALHAMBRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 918013705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262818663 | ||||||||
| FaxNumber: | 6262816318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 05/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | FUNG | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6262818663 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | CH4605 | 01 | CA | MEDICARE RAILROAD | OTHER | ZZZ58519Z | 01 | CA | BLUE SHIELD | OTHER | GR0089890 | 05 | CA | MEDICAID |