Provider Demographics
NPI:1902266869
Name:TOTAL BODY CENTER INC
Entity Type:Organization
Organization Name:TOTAL BODY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:TANG
Authorized Official - Last Name:HANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:626-282-1988
Mailing Address - Street 1:41 N GARFIELD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3556
Mailing Address - Country:US
Mailing Address - Phone:626-282-1988
Mailing Address - Fax:626-236-5464
Practice Address - Street 1:41 N GARFIELD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3556
Practice Address - Country:US
Practice Address - Phone:626-282-1988
Practice Address - Fax:626-236-5464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28952261QC1500X, 261QC1800X, 261QH0100X, 261QM1100X, 261QM1300X, 261QM2500X, 261QP0905X, 261QP2000X, 261QP3300X, 261QR0401X, 261QS1000X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADE140AMedicare PIN