| Vita Plus Health Center | |
|
1817 W Orangethorpe Ave Fullerton CA 92833-4405 | |
| (714) 449-0911 | |
| Not Available |
| Full Name | Vita Plus Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1817 W Orangethorpe Ave, Fullerton, California |
| Authorized Official Name and Position | Yong Soon Shin (NP) |
| Authorized Official Contact | 7143497347 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vita Plus Health Center 1817 W Orangethorpe Ave Fullerton CA 92833-4405 Ph: (714) 449-0911 | Vita Plus Health Center 1817 W Orangethorpe Ave Fullerton CA 92833-4405 Ph: (714) 449-0911 |
| NPI Number | 1063040228 |
|---|---|
| Provider Enumeration Date | 03/31/2020 |
| Last Update Date | 11/11/2020 |
| Medicare PECOS PAC ID | 3476963877 |
|---|---|
| Medicare Enrollment ID | O20201112002630 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063040228 | NPI | - | NPPES |
| 95005514 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Yong Soon Shin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366985129 PECOS PAC ID: 7416231253 Enrollment ID: I20170223000663 |
| Provider Name | Yujia Yang |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1598412231 PECOS PAC ID: 7012302102 Enrollment ID: I20220329000505 |
| Provider Name | Angela Kim |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1871066647 PECOS PAC ID: 6901284546 Enrollment ID: I20220609001918 |
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