| Innova Physician Network | |
|
1403 N. Fair Oaks Avenue Suite 3 Pasadena CA 91103 | |
| (323) 639-6593 | |
| (626) 398-0357 |
| Full Name | Innova Physician Network |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1403 N. Fair Oaks Avenue, Pasadena, California |
| Authorized Official Name and Position | Joon Park (DIRECTOR OF NETWORK DEVELOPMENT) |
| Authorized Official Contact | 3236396593 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innova Physician Network 1403 N. Fair Oaks Avenue Suite 3 Pasadena CA 91103 | Innova Physician Network 1403 N. Fair Oaks Avenue Suite 3 Pasadena CA 91103 Ph: (323) 639-6593 |
| NPI Number | 1629659016 |
|---|---|
| Provider Enumeration Date | 04/16/2021 |
| Last Update Date | 04/16/2021 |
| Certification Date | 04/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629659016 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
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