Basic Information
| Provider Information | |||||||||
| NPI: | 1396947883 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PACIFIC ASIAN COUNSELING SERVICES | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | PACIFIC ASIAN COUNSELING SERVICE LONG BEACH | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8616 LA TIJERA BLVD | ||||||||
| Address2: | #200 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900453944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103371550 | ||||||||
| FaxNumber: | 3103372805 | ||||||||
| Practice Location | |||||||||
| Address1: | 3530 ATLANTIC AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908074569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624241886 | ||||||||
| FaxNumber: | 5624242296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 10/05/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | QUON | ||||||||
| AuthorizedOfficialFirstName: | MYRON | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3103371550 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | ESQ. | ||||||||
| NPICertificationDate: | 10/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 7426B | 01 | CA | MEDICAL REPORTING UNIT NU | OTHER |