Provider Demographics
NPI:1558300020
Name:CENTRAL HEMATOLOGYONCOLOGY MEDICAL GROUP, INC
Entity type:Organization
Organization Name:CENTRAL HEMATOLOGYONCOLOGY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:HL
Authorized Official - Last Name:HU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-588-2825
Mailing Address - Street 1:707 S GARFIELD AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4438
Mailing Address - Country:US
Mailing Address - Phone:626-588-2825
Mailing Address - Fax:626-588-2850
Practice Address - Street 1:707 S GARFIELD AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4438
Practice Address - Country:US
Practice Address - Phone:626-588-2825
Practice Address - Fax:626-588-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46840174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092870Medicaid
CAGR0092870Medicaid
CA5003070001Medicare NSC