NPIMap

Organization Active NPI

Northeast Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Hawthorne, CA
National Provider Identifier
1275226334
Registry record updated Jun 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHEAST COMMUNITY CLINIC
Practice address
4455 W. 117TH St Suite 105
Hawthorne, CA 90250-2241
Phone
(424) 456-6200
Fax
(424) 456-6201
NPI assigned
Jun 2, 2023
Last updated
Jun 2, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Christopher Tak Lau, MDNPI 1548365968
Title
Executive Director
Phone
(626) 457-6900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

4455 W. 117TH St Suite 105
Hawthorne, CA 90250-2241

Mailing address

2550 W Main St Ste 301
Alhambra, CA 91801-7003
Phone (626) 457-6900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040417000619 CA Part B Supplier - Clinic/Group Practice 5193710275 Receives reassigned benefits from 65 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bell, CA; Harbor City, CA; Hawthorne, CA; Huntington Park, CA; Los Angeles, CA; Wilmington, CA
O20250701004288 CA Part A Provider - Federally Qualified Health Center (FQHC) 5193710275 Practice locations: Hawthorne, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275226334. Details of each certification follow.

Federally qualified health center certification: CCN A01958

Legal name
NORTHEAST COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 29, 2025
Last certification
May 29, 2025
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
4455 W 117TH St
Ste 105
Hawthorne, CA 90250-2240

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Northeast Community Clinic9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4455 W 117th St
Ste 200
Hawthorne, CA 90250
Phone (310) 219-2000

231 W Vernon Ave
Ste 203
Los Angeles, CA 90037
Phone (323) 231-8814

3751 S Harvard Blvd
Los Angeles, CA 90018
Phone (213) 742-6070

5820 N Figueroa St
Los Angeles, CA 90042
Phone (323) 255-6000

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Octavio Fierros Individual Corporate DirectorBoard of Director May 1, 2018
Fumio Robert Nakahiro Individual Corporate DirectorBoard of Director May 16, 1999
Irene Huerta Individual Corporate DirectorBoard of Director Aug 1, 2010
Ali Mohammad Tweini Individual Corporate DirectorBoard of Director Oct 1, 2009
Christopher T Lau Individual Corporate DirectorExecutive Director Aug 4, 1997
W-2 Managing EmployeeExecutive Director Aug 4, 1997
Ruby Y Medrano Individual Corporate DirectorBoard of Director May 16, 1999
Dalia M Jaramillo Individual Corporate DirectorBoard of Director Jul 6, 2006
Monica Guardian Individual Corporate DirectorBoard of Director Sep 1, 2014
Renia Carrillo Individual Corporate DirectorBoard of Director May 15, 2025
Carlos Soto Individual Corporate DirectorBoard of Director May 15, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 64

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 64

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685664000000",
    "number": "1275226334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 W MAIN ST STE 301",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918017003",
            "telephone_number": "626-457-6900",
            "fax_number": "626-457-5022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 W. 117TH ST SUITE 105",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902502241",
            "telephone_number": "424-456-6200",
            "fax_number": "424-456-6201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-02",
        "last_updated": "2023-06-02",
        "certification_date": "2023-05-25",
        "status": "A",
        "authorized_official_last_name": "LAU",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "TAK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "626-457-6900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hawthorne, CA

Sources for this page

Verify at the official NPI Registry.