Provider Demographics
NPI:1689495673
Name:YEHOWA MEDICAL SERVICES
Entity type:Organization
Organization Name:YEHOWA MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TWEH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:323-776-1500
Mailing Address - Street 1:24404 VERMONT AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2321
Mailing Address - Country:US
Mailing Address - Phone:323-776-1500
Mailing Address - Fax:424-263-5249
Practice Address - Street 1:5720 E. IMPERIAL HWY
Practice Address - Street 2:N-O
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280
Practice Address - Country:US
Practice Address - Phone:323-776-1500
Practice Address - Fax:855-777-2289
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YEHOWA MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)