Provider Demographics
NPI:1295154672
Name:GOLDOME HEALTHCARE INC.
Entity type:Organization
Organization Name:GOLDOME HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-334-1939
Mailing Address - Street 1:3191 W TEMPLE AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-3228
Mailing Address - Country:US
Mailing Address - Phone:909-895-3299
Mailing Address - Fax:909-895-4801
Practice Address - Street 1:3191 W TEMPLE AVE STE 190
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3228
Practice Address - Country:US
Practice Address - Phone:909-895-3299
Practice Address - Fax:909-895-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82411261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB216066Medicare PIN