Century Pho, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

CENTURY PHO, INC.

Practice address

1029 N Sacramento Ave
Chicago, IL 60622-2746

Phone

(773) 278-8555

Fax

(773) 278-7515

NPI assigned

Feb 28, 2007

Organization subpart

No

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

Authorized official

Name

Kita Johnson

Title

Executive Director

Phone

(773) 278-8685

Specialties & licenses 1

Addresses

Other names 1

• Humboldt Park Health Partners Doing business as

Locations

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614729600000",
    "number": "1508994831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1029 N. SACRAMENTO AVE.",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60622",
            "telephone_number": "773-278-8555",
            "fax_number": "773-278-7515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 N SACRAMENTO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606222746",
            "telephone_number": "773-278-8555",
            "fax_number": "773-278-7515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTURY PHO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KITA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "773-278-8685"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Humboldt Park Health Partners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialist in Chicago, IL
• Providers in Chicago, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.