Individual provider Active NPI

Chinhnam Hathuc, D.O.

  • Family Medicine Physician
  • Long Beach, CA
National Provider Identifier
1306103783
Registry record updated Apr 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A12261 Issued in CA
Practice address
2776 Pacific Ave
Long Beach, CA 90806-2613
Phone
(562) 997-2000
NPI assigned
Apr 23, 2012
Last updated
Apr 23, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 23, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A12261 CA Primary

Addresses

Primary practice location

2776 Pacific Ave
Long Beach, CA 90806-2613

Mailing address

10277 Corte Fina LN
Bellflower, CA 90706-1072

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131018001913 CA Practitioner - Family Practice 4688809080 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1555 S Garey Ave
Pomona, CA 91766-5222
Phone (626) 919-4333

420 S Glendora Ave
West Covina, CA 91790-3001
Phone 6269194333259

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A12261CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East Valley Community Health Center, Inc. CurrentSince Aug 28, 2013 Accepting new patients
East Valley Community Health Center, Inc. CurrentSince Aug 28, 2013 Accepting new patients
Joseph M Molina MD Professional Corporation-Southern California Family Medicine Past Accepting new patients

Locations

1555 S Garey Ave
Pomona, CA 91766
Phone (909) 620-8088

420 S Glendora Ave
West Covina, CA 91790
Phone (626) 919-5724

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: chinhnam.hathuc.p1@direct.evchc.nextgenshare.com

Ownership & related parties

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
East Valley Community Health Center, Inc.West Covina, CA, CCN 551951 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jul 1, 2014
Jul 1, 2014
East Valley Community Health Center, Inc.Pomona, CA, CCN 551952 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jul 1, 2014
Jul 1, 2014
East Valley Community Health Center/Villacorta School ClinicLa Puente, CA, CCN 551199 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jul 1, 2014
Jul 1, 2014
East Valley Community Health Center, Inc Covina Health CenterCovina, CA, CCN 751156 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jul 1, 2014
Jul 1, 2014
East Valley Community Health Center, Inc. - Pomona ShelterEl Monte, CA, CCN 921953 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jul 1, 2014
Jul 1, 2014
East Valley Community Health Center, Inc.Pomona, CA, CCN 921918 Federally qualified health center Corporate Officer
W-2 Managing Employee
Jul 1, 2014
Jul 1, 2014

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335139200000",
    "number": "1306103783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10277 CORTE FINA LN",
            "city": "BELLFLOWER",
            "state": "CA",
            "postal_code": "907061072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2776 PACIFIC AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908062613",
            "telephone_number": "562-997-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATHUC",
        "first_name": "CHINHNAM",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-23",
        "last_updated": "2012-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A12261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.