NPIMap

Organization Active NPI

Alhambra Family Medical Center

  • Family Medicine Physician
  • Alhambra, CA
National Provider Identifier
1851324206
Registry record updated Mar 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ALHAMBRA FAMILY MEDICAL CENTER
Practice address
1336 W. Valley Blvd, #a
Alhambra, CA 91803-3257
Phone
(626) 281-2232
Fax
(626) 281-7214
NPI assigned
Jul 9, 2006
Last updated
Mar 20, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2014

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

Authorized official

Name
Dr. Jacqueline Wong, M.D.NPI 1114968393
Title
President
Phone
(626) 281-2232

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X

Addresses

Primary practice location

1336 W. Valley Blvd, #a
Alhambra, CA 91803-3257

Mailing address

1336 W. Valley Blvd, #a
Alhambra, CA 91803-3257
Phone (626) 281-2232

Other identifiers 4

IdentifierTypeStateIssuer
00AX67580MedicaidCA
GR0093620MedicaidCA
00A848670MedicaidCA
05D0565444OtherCACLIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041116001221 CA Part B Supplier - Clinic/Group Practice 2264496579 Receives reassigned benefits from 4 practitioners
Practice locations: Alhambra, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0565444Alhambra Family Medical Center1336 W Valley Blvd Ste a, Alhambra, CA 91803Certificate of waiverJan 23, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395273600000",
    "number": "1851324206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1336 W. VALLEY BLVD, #A",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918033257",
            "telephone_number": "626-281-2232",
            "fax_number": "626-281-7214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1336 W. VALLEY BLVD, #A",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918033257",
            "telephone_number": "626-281-2232",
            "fax_number": "626-281-7214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALHAMBRA FAMILY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2014-03-20",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-281-2232",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX67580",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0093620",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A848670",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D0565444",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alhambra, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.