Provider Demographics
NPI:1780982017
Name:MY PEDIATRIC MEDICAL CLINIC INC
Entity type:Organization
Organization Name:MY PEDIATRIC MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HANAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:HAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-989-1166
Mailing Address - Street 1:2777 PACIFIC AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2625
Mailing Address - Country:US
Mailing Address - Phone:562-989-1166
Mailing Address - Fax:562-989-1188
Practice Address - Street 1:2777 PACIFIC AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2625
Practice Address - Country:US
Practice Address - Phone:562-989-1166
Practice Address - Fax:562-989-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty