2020قدددللىذلد يمدقم تامدلخا تايلديصلاوblue shield ... · blue...
TRANSCRIPT
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H0148_20_141_PNO_lA_DEC_AB_Accepted Date 11/22/2020
2020لدددقوالصيدليات اخلدمات مقدمي دلذىل
Blue Shield Promise Cal MediConnect Plan((Medicare-Medicaid Plan
املقاطعة: Los Angeles أجنلوس( )لوس
القائه وإذى بًاخلطة، ذذهـدق هـامة لومات٠مع ءى زالصدول 2020 لعًام وال^يدليات اخلدمًات ندددي دذدل إدى لرجوع١ دروى ازتابعةل اخددماتوالصديدليات اإلضافةملذدمي Blue Shield Promise Cal MediConnect اسحق هـذا يتضمن
ت -خدمل.ارهشل مبقدقدمي املت.هة ب؛ملطوم؛ت حمدثة قائمةربمسيد٠ إىل إض.افة يدملخدم.ات الًيقا دمد من املطبوعة نسخة اذ إن
www. blues.hieldca.com/ بويًا عالًيض ةرقا٠زياعو ميك-ذك ىختدم-'ت. حمد:ئةفإ ذءت مظوأوأن تضمدان ئعاي املحلق promise/calmediconnect؛بت4خ هلز ابرر٠'التص أو Blue Sheld Promise Cal MediConnect دواذصدددب االدمات مق.دذدي ءن معدذومات ءى زالصدول أدناه اذوارد اهلادف .رؤم
اعضاء خدمات Blue Shield Promise Cal MediConnect 3825-905-855-1 الساة( من (711 اؤذصدي: اهلاذئاألسبوع أي-ام ل١طو دساء، 8:00 إىل صباحا 8:00
من. اءتب-را ساري املحلق هـذا ترب ى 2020 ربمسيد.
CaliforniaاجالداPromise Health Plan
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المحتويات جدول
1الشبكات مزودي قائمةALLIED PHYSICIANS IPA OF CA DBA ALLIED PACIFIC IPA
.................................................... األولي الصحية الرعاية أطباء.......................................................................... المتخصصين
ALTAMED - MONTEREY PARK.................................................... األولي الصحية الرعاية أطباء
.......................................................................... المتخصصينALTAMED HEALTH SERVICES CORPORATION
.................................................... األولي الصحية الرعاية أطباء.......................................................................... المتخصصين
ANGELES IPA.................................................... األولي الصحية الرعاية أطباء
.......................................................................... المتخصصينAPPLECARE MEDICAL GROUP- DOWNEY
.................................................... األولي الصحية الرعاية أطباءAPPLECARE MEDICAL GROUP- SELECT
.................................................... األولي الصحية الرعاية أطباءAPPLECARE MEDICAL GROUP- WHITTIER
.................................................... األولي الصحية الرعاية أطباءAPPLECARE MEDICAL GROUP-ST FRANCIS
.................................................... األولي الصحية الرعاية أطباء.......................................................................... المتخصصين
BLUE SHIELD PROMISE HEALTH PLAN DIRECT.......................................................................... المتخصصين
COMMUNITY FAMILY CARE - VALLEY PRES.................................................... األولي الصحية الرعاية أطباء
.......................................................................... المتخصصينCOMMUNITY FAMILY CARE-AV
.................................................... األولي الصحية الرعاية أطباءFAMILY CARE SPECIALIST IPA
.......................................................................... المتخصصينHEALTH CARE LA IPA
.................................................... األولي الصحية الرعاية أطباء
1 .5 .
1011
1519
2929
32
34
37
3939
41
4243
45
46
55
1-855-905-3825الرقم على Blue Shield Promise Cal MediConnect Plan مع التواصل فيرجى أسئلة، لديك كانت إذاالمعلومات، من لمزيد مجانية. المكالمة وتكون األسبوع. أيام مساءً.طوال 8:00 إلى صباحًا 8:00 الساعة (من711النصي: )هاتف
.www.blueshieldca.com/promise/calmediconnect بزيارة تفضل
I
http://www.blueshieldca.com/promise/calmediconnect
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56 ......................................................................................................................................... المتخصصينHEALTHCARE PARTNERS
79 ................................................................................................................... األولي الصحية الرعاية أطباء80 ......................................................................................................................................... المتخصصين
HEALTHCARE PARTNERS MEDICAL GROUP - DEL AMO88 ......................................................................................................................................... المتخصصين
KOREAN AMERICAN MEDICAL GROUP90 ......................................................................................................................................... المتخصصين
OPTUM - ALHAMBRA94 ................................................................................................................... األولي الصحية الرعاية أطباء
OPTUM - ARCADIA95 ................................................................................................................... األولي الصحية الرعاية أطباء
OPTUM - BIXBY KNOLLS96 ......................................................................................................................................... المتخصصين
OPTUM - DOWNTOWN LONG BEACH97 ......................................................................................................................................... المتخصصين
OPTUM - EL MONTE98 ......................................................................................................................................... المتخصصين
OPTUM - LAKEWOOD99 ......................................................................................................................................... المتخصصين
OPTUM - LONG BEACH100 ....................................................................................................................................... المتخصصين
OPTUM - MONTEBELLO101 ....................................................................................................................................... المتخصصين
OPTUM - MONTEREY PARK102 ....................................................................................................................................... المتخصصين
OPTUM - PASADENA MAIN103 ....................................................................................................................................... المتخصصين
OPTUM - REDONDO BEACH104 ................................................................................................................. األولي الصحية الرعاية أطباء
OPTUM - SAN ANTONIO105 ....................................................................................................................................... المتخصصين
OPTUM - SOUTH BAY-COASTAL106 ....................................................................................................................................... المتخصصين
OPTUM - SPRING
1-855-905-3825الرقم على Blue Shield Promise Cal MediConnect Plan مع التواصل فيرجى أسئلة، لديك كانت إذاالمعلومات، من لمزيد مجانية. المكالمة وتكون األسبوع. أيام مساءً.طوال 8:00 إلى صباحًا 8:00 الساعة (من711النصي: )هاتف
.www.blueshieldca.com/promise/calmediconnect بزيارة تفضل
II
http://www.blueshieldca.com/promise/calmediconnect
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107 ....................................................................................................................................... المتخصصينOPTUM - VAN NUYS
108 ................................................................................................................. األولي الصحية الرعاية أطباءOPTUM - WILLOW
109 ....................................................................................................................................... المتخصصينOPTUM CARE NETWORK - EAST LA
110 ................................................................................................................. األولي الصحية الرعاية أطباءOPTUM CARE NETWORK - EAST WEST
111 ................................................................................................................. األولي الصحية الرعاية أطباءOPTUM CARE NETWORK - GLENDALE
113 ................................................................................................................. األولي الصحية الرعاية أطباءOPTUM CARE NETWORK - LITTLE CO OF MARY
115 ................................................................................................................. األولي الصحية الرعاية أطباء117 ....................................................................................................................................... المتخصصين
OPTUM CARE NETWORK - LONG BEACH120 ................................................................................................................. األولي الصحية الرعاية أطباء
121 ....................................................................................................................................... المتخصصينOPTUM CARE NETWORK - NORTHRIDGE MG
123 ................................................................................................................. األولي الصحية الرعاية أطباءOPTUM CARE NETWORK - PASADENA
124 ................................................................................................................. األولي الصحية الرعاية أطباءOPTUM CARE NETWORK - SGV-GLEN-BEV
125 ................................................................................................................. األولي الصحية الرعاية أطباء127 ....................................................................................................................................... المتخصصين
OPTUM CARE NETWORK - SOUTH BAY129 ................................................................................................................. األولي الصحية الرعاية أطباء
130 ....................................................................................................................................... المتخصصينOPTUM CARE NETWORK - SOUTH COAST
132 ................................................................................................................. األولي الصحية الرعاية أطباءPREFERRED IPA OF CALIFORNIA
133 ................................................................................................................. األولي الصحية الرعاية أطباء137 ....................................................................................................................................... المتخصصين
PRIMARY CARE ASSOCIATES OF CALIFORNIA140 ................................................................................................................. األولي الصحية الرعاية أطباء
140 ....................................................................................................................................... المتخصصين
1-855-905-3825الرقم على Blue Shield Promise Cal MediConnect Plan مع التواصل فيرجى أسئلة، لديك كانت إذاالمعلومات، من لمزيد مجانية. المكالمة وتكون األسبوع. أيام مساءً.طوال 8:00 إلى صباحًا 8:00 الساعة (من711النصي: )هاتف
.www.blueshieldca.com/promise/calmediconnect بزيارة تفضل
III
http://www.blueshieldca.com/promise/calmediconnect
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PROSPECT HEALTHSOURCE MEDICAL GROUP144 ................................................................................................................. األولي الصحية الرعاية أطباء
144 ....................................................................................................................................... المتخصصينPROSPECT MEDICAL GROUP-LOS ANGELES
154 ................................................................................................................. األولي الصحية الرعاية أطباء156 ....................................................................................................................................... المتخصصين
PROSPECT MEDICAL GROUP-VAN NUYS173 ................................................................................................................. األولي الصحية الرعاية أطباء
173 ....................................................................................................................................... المتخصصينPROSPECT NWOC MEDICAL GROUP-LA
180 ................................................................................................................. األولي الصحية الرعاية أطباء180 ....................................................................................................................................... المتخصصين
PROSPECT PROFESSIONAL CARE MED GRP LA182 ................................................................................................................. األولي الصحية الرعاية أطباء
185 ....................................................................................................................................... المتخصصينPROSPECT-NUESTRA FAMILIA MEDICAL GROUP
206 ................................................................................................................. األولي الصحية الرعاية أطباء207 ....................................................................................................................................... المتخصصين
PROSPECT-SAN MIGUEL IPA213 ....................................................................................................................................... المتخصصين
SEOUL MEDICAL GROUP221 ................................................................................................................. األولي الصحية الرعاية أطباء
221 ....................................................................................................................................... المتخصصينTORRANCE MEMORIAL IPA
230 ................................................................................................................. األولي الصحية الرعاية أطباء231 ....................................................................................................................................... المتخصصين
233 ....................................................................................................................................... باإلبر العالج304 ................................................................................................................... العقلية الصحة خدمات مقدمي347 ......................................................................................................................................... الرؤية مقدمي421 ........................................................................................................................... العقلية الصحة مرافق
423 ................................................................................... الصيدليات وسالسل بالتجزئة البيع صيدليات501 ...................................................................................................................... المنزلي الحقن صيدليات503 ............................................................................................................... األجل طويلة الرعاية صيدليات
507 ............................................................................................................................................. مزود مؤشر514 ...................................................................................................................................... الصيدلة مؤشر
1-855-905-3825الرقم على Blue Shield Promise Cal MediConnect Plan مع التواصل فيرجى أسئلة، لديك كانت إذاالمعلومات، من لمزيد مجانية. المكالمة وتكون األسبوع. أيام مساءً.طوال 8:00 إلى صباحًا 8:00 الساعة (من711النصي: )هاتف
.www.blueshieldca.com/promise/calmediconnect بزيارة تفضل
IV
http://www.blueshieldca.com/promise/calmediconnect
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LOS ANGELES COUNTY MEDICAL GROUPS ALLIED PHYSICIANS IPA OF CA DBA ALLIED PACIFIC IPA
PRIMARY CARE PHYSICIANS
Family Practice
DIAMOND BAR
91765
Chen, David MD
2705 S Diamond Bar Blvd Ste
100
Diamond Bar, CA 91765
(626) 965-1988
Provider ID: 240691
License: A82411
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Chinese,
Mandarin, Spanish,
Taiwanese
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
LA PUENTE
91744
Urbina, Marvin MD
1431 N Hacienda Blvd
La Puente, CA 91744
(626) 338-4088
Provider ID: 85954
License: A71133
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Spanish,
Tagalog
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
NORWALK
90650
Bejinez-eastman, Ana MD
13820 San Antonio Dr
Norwalk, CA 90650
(562) 908-4355
Provider ID: 209015
License: G67654
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
WEST COVINA
91790
Velez Dalla Tor, Maili MD
1135 S Sunset Ave Ste 401
West Covina, CA 91790
(626) 732-8390
Provider ID: 269096
License: A71918
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 1change
www.blueshieldca.com/promise/calmediconnect
-
91792
LOS ANGELES COUNTY MEDICAL GROUPS ALLIED PHYSICIANS IPA OF CA DBA ALLIED PACIFIC IPA
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Chen, David MD
2707 E Valley Blvd Ste 203
West Covina, CA 91792
(626) 965-1988
Provider ID: 109805
License: A82411
Credentials and/or board
certification: No
Accepting New Members: No
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Chinese,
Mandarin, Spanish,
Taiwanese
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
General Practice
BALDWIN PARK
91706
Carrillo, Herman MD
14342 Ramona Blvd
Baldwin Park, CA 91706
(626) 918-3828
Provider ID: 210188
License: A45086
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: Yes
Other Language: Spanish
Cultural Competency: NR
Accessibility: B, W; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
LOS ANGELES
90022
Tek, Rotana DO
4755 E Cesar E Chavez Ave
Los Angeles, CA 90022
(323) 268-9191
Provider ID: 252846
License: 20A13698
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Cambodian
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 2change
www.blueshieldca.com/promise/calmediconnect
-
LOS ANGELES COUNTY MEDICAL GROUPS ALLIED PHYSICIANS IPA OF CA DBA ALLIED PACIFIC IPA
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Tek, Rotana DO
507 S Atlantic Blvd
Los Angeles, CA 90022
(323) 268-9191
Provider ID: 252848
License: 20A13698
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Cambodian
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
POMONA
91768
Rodriguez, Antonio MD
630 N Park Ave
Pomona, CA 91768
(909) 622-3755
Provider ID: 246508
License: A109646
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Internal Medicine
LOS ANGELES
90012
Wong, Nga MD
819 W Cesar E Chavez Ave
Los Angeles, CA 90012
(213) 613-1255
Provider ID: 2442
License: A26311
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: Yes
Other Language: Chinese
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
MONTEBELLO
90640
Chaudhry, Mohammad MD
101 E Beverly Blvd Ste 401
Montebello, CA 90640
(323) 722-2260
Provider ID: 209557
License: A54998
Credentials and/or board
certification: Yes
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 3change
www.blueshieldca.com/promise/calmediconnect
-
91766
LOS ANGELES COUNTY MEDICAL GROUPS ALLIED PHYSICIANS IPA OF CA DBA ALLIED PACIFIC IPA
Accepting New Members: Yes office to discuss their present.
Hours: M-SA 9AM-5PM
PTA: No
Cultural Competency: NR
Accessibility: B, W; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
POMONA
Kingsley, Anthony MD
2286 S Garey Ave
Pomona, CA 91766
(909) 464-2818
Provider ID: 80822
License: G84127
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: Yes
Other Language: Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
ROSEMEAD
91770
Wong, Tan MD
7770 Garvey Ave
Rosemead, CA 91770
(626) 307-4785
Provider ID: 209445
License: A50496
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Burmese,
Mandarin, Spanish,
Vietnamese
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
WEST COVINA
91790
Taylor, Randy MD
140 N Orange Ave Ste 100
West Covina, CA 91790
(626) 800-4200
Provider ID: 238852
License: C42157
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Spanish,
Tagalog
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 4change
www.blueshieldca.com/promise/calmediconnect
-
91801
LOS ANGELES COUNTY MEDICAL GROUPS ALLIED PHYSICIANS IPA OF CA DBA ALLIED PACIFIC IPA
SPECIALISTS
Members may not self-refer to
any of the specialists listed
below. To receive covered
services from a specialist you
must receive a referral from
your primary care physician.
Cardiovascular Disease
ALHAMBRA
Yee, Henry MD
35 S Garfield Ave
Alhambra, CA 91801
(626) 458-8818
Provider ID: 9797
License: A62192
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: Yes
Other Language: Burmese,
Cantonese, Mandarin,
Spanish, Vietnamese, Yue
Chinese
Cultural Competency: NR
Accessibility: B, W; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Gastroenterology
POMONA
91767
Elbatta, Mohammad MD
790 E Bonita Ave Fl 2
Pomona, CA 91767
(909) 447-8593
Provider ID: 247063
License: A162124
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Arabic,
Armenian
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Ophthalmology
LOS ANGELES
90017
Boyer, David MD
1245 Wilshire Blvd Ste 380
Los Angeles, CA 90017
(951) 296-1188
Provider ID: 123989
License: G25107
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Armenian,
Chinese, Faroese, Farsi,
Hebrew, Korean, Mandarin,
Russian
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 5change
www.blueshieldca.com/promise/calmediconnect
-
LOS ANGELES COUNTY MEDICAL GROUPS ALLIED PHYSICIANS IPA OF CA DBA ALLIED PACIFIC IPA
Special Expertise: Deafness or
Hard-of-Hearing, Blindness or
Visual Impairment,
Co-occuring Disorders
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Chu, Thomas MD
1245 Wilshire Blvd Ste 380
Los Angeles, CA 90017
(951) 296-1188
Provider ID: 123893
License: G68694
Credentials and/or board
certification: Yes
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Armenian,
Korean, Mandarin, Russian,
Spanish, Tagalog
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Novack, Roger MD
1245 Wilshire Blvd Ste 380
Los Angeles, CA 90017
(951) 296-1188
Provider ID: 123978
License: G53779
Credentials and/or board
certification: Yes
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Cantonese,
Faroese, Farsi
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
Special Expertise: Deafness or
Hard-of-Hearing, Co-occuring
Disorders
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Narala, Ramsudha MD
1245 Wilshire Blvd Ste 380
Los Angeles, CA 90017
(213) 483-8810
Provider ID: 270349
License: A147844
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Pediatrics
POMONA
91767
Chung, Gloria Ha DO
1101 E Holt Ave Ste G
Pomona, CA 91767
(909) 632-0895
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 6change
www.blueshieldca.com/promise/calmediconnect
-
90012
LOS ANGELES COUNTY MEDICAL GROUPS ALLIED PHYSICIANS IPA OF CA DBA ALLIED PACIFIC IPA
Provider ID: 268804
License: 20A11437
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Spanish,
Vietnamese
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Podiatrist
LOS ANGELES
Lee, Edmond DPM
711 W College St Ste 520
Los Angeles, CA 90012
(213) 620-8702
Provider ID: 1411
License: DPM4038
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: Yes
Other Language: Chinese,
Mandarin, Spanish
Cultural Competency: NR
Accessibility: B, W; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
Special Expertise: Deafness or
Hard-of-Hearing, Co-occuring
Disorders
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Surgery Cardiovascular
90033
Nucho, Ramsay MD
1701 E Cesar E Chavez Ave
Ste 300
Los Angeles, CA 90033
(818) 242-6828
Provider ID: 15634
License: C41229
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: Yes
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Surgery General
Khan, Faisal MD
1701 E Cesar E Chavez Ave
Ste 300
Los Angeles, CA 90033
(818) 242-6828
Provider ID: 18246
License: G45343
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: Yes
Other Language: Armenian
Cultural Competency: NR
Accessibility: B; Members
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 7change
www.blueshieldca.com/promise/calmediconnect
-
LOS ANGELES COUNTY MEDICAL GROUPS ALLIED PHYSICIANS IPA OF CA DBA ALLIED PACIFIC IPA
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Tan, Matthew MD
1701 E Cesar E Chavez Ave
Ste 300
Los Angeles, CA 90033
(818) 242-6828
Provider ID: 7298
License: G19327
Credentials and/or board
certification: Yes
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: Yes
Other Language: Armenian,
Cantonese, Chinese,
Indonesian, Mandarin,
Spanish, Tagalog
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Surgery Orthopedic
ENCINO
91316
Oheb, Jonathan MD
5363 Balboa Blvd Ste 445
Encino, CA 91316
(818) 946-8424
Provider ID: 270354
License: A128003
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Farsi,
Hebrew, Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
GLENDORA
91741
Wong, Kee MD
412 W Carroll Ave Ste 107
Glendora, CA 91741
(626) 914-4890
Provider ID: 32134
License: G32749
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Mandarin
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Yi, Rosemary MD
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 8change
www.blueshieldca.com/promise/calmediconnect
-
91790
LOS ANGELES COUNTY MEDICAL GROUPS ALLIED PHYSICIANS IPA OF CA DBA ALLIED PACIFIC IPA
412 W Carroll Ave Ste 107
Glendora, CA 91741
(626) 914-4890
Provider ID: 273591
License: A167617
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
WEST COVINA
Yi, Rosemary MD
1135 S Sunset Ave Ste 200
West Covina, CA 91790
(626) 918-6655
Provider ID: 273593
License: A167617
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 9change
www.blueshieldca.com/promise/calmediconnect
-
90033
LOS ANGELES COUNTY MEDICAL GROUPS ALTAMED - MONTEREY PARK
PRIMARY CARE PHYSICIANS
Family Practice
LOS ANGELES
Madatovian, Harut DO
2928 E Cesar E Chavez Ave
Los Angeles, CA 90033
(626) 458-8401
Provider ID: 245424
License: 20A15143
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Armenian,
Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
SOUTH GATE
90280
Madatovian, Harut DO
5831 Firestone Blvd Ste E
South Gate, CA 90280
(626) 458-8401
Provider ID: 245421
License: 20A15143
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Armenian,
Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Internal Medicine
ALHAMBRA
91801
Chan, Robert MD
1234 S Garfield Ave Ste 103
Alhambra, CA 91801
(626) 576-7871
Provider ID: 269044
License: A67678
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: Yes
Other Language: Cantonese,
Croatian, Mandarin, Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
LOS ANGELES
90012
Wong, Nga MD
819 W Cesar E Chavez Ave
Los Angeles, CA 90012
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 10change
www.blueshieldca.com/promise/calmediconnect
-
LOS ANGELES COUNTY MEDICAL GROUPS ALTAMED - MONTEREY PARK
(213) 613-1255
Provider ID: 43042
License: A26311
Credentials and/or board
certification: No
Accepting New Members: No
Hours: M-SA 9AM-5PM
PTA: Yes
Other Language: Chinese
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
SPECIALISTS
Members may not self-refer to
any of the specialists listed
below. To receive covered
services from a specialist you
must receive a referral from
your primary care physician.
Cardiovascular Disease
ROSEMEAD
91770
Cao, Michael MD
8729 Valley Blvd Ste B
Rosemead, CA 91770
(626) 451-0086
Provider ID: 272549
License: A80802
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Chinese,
Spanish, Vietnamese
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
Special Expertise: Deafness or
Hard-of-Hearing, Co-occuring
Disorders
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Cao, Michael MD
8729 Valley Blvd Ste C
Rosemead, CA 91770
(626) 451-0086
Provider ID: 272552
License: A80802
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Chinese,
Spanish, Vietnamese
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
Special Expertise: Deafness or
Hard-of-Hearing, Co-occuring
Disorders
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Hematology / Oncology
LOS ANGELES
90015
Ali, Sami MD
1513 S Grand Ave Ste 360
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 11change
www.blueshieldca.com/promise/calmediconnect
-
90020
LOS ANGELES COUNTY MEDICAL GROUPS ALTAMED - MONTEREY PARK
Los Angeles, CA 90015
(213) 246-2422
Provider ID: 244540
License: A149539
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Armenian,
Japanese, Korean, Russian,
Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Neurology Child
Kim, James MD
520 S Virgil Ave Ste 307
Los Angeles, CA 90020
(213) 386-6755
Provider ID: 91548
License: A49011
Credentials and/or board
certification: Yes
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: Yes
Other Language: Korean,
Spanish
Cultural Competency: NR
Accessibility: B, W; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Neurology
WEST COVINA
91790
Kundi, Mukhtair MD
1900 W Garvey Ave S Ste 166
West Covina, CA 91790
(626) 960-1402
Provider ID: 241892
License: A41283
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Hindi,
Punjabi
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Ophthalmology
LOS ANGELES
90017
Tabandeh, Homayoun MD
1245 Wilshire Blvd Ste 380
Los Angeles, CA 90017
(213) 483-8810
Provider ID: 239732
License: A89087
Credentials and/or board
certification: Yes
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 12change
www.blueshieldca.com/promise/calmediconnect
-
90057
LOS ANGELES COUNTY MEDICAL GROUPS ALTAMED - MONTEREY PARK
Other Language: Armenian,
Faroese, Farsi, Korean,
Mandarin, Russian, Spanish,
Tagalog
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
Special Expertise: Deafness or
Hard-of-Hearing, Co-occuring
Disorders
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Salib, George MD
139 S Alvarado St
Los Angeles, CA 90057
(213) 484-0170
Provider ID: 202973
License: A71222
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: Yes
Other Language: Arabic,
Cantonese, French, Spanish,
Tagalog
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Podiatrist
90012
Lee, Edmond DPM
711 W College St Ste 520
Los Angeles, CA 90012
(213) 620-8702
Provider ID: 1411
License: DPM4038
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: Yes
Other Language: Chinese,
Mandarin, Spanish
Cultural Competency: NR
Accessibility: B, W; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
Special Expertise: Deafness or
Hard-of-Hearing, Co-occuring
Disorders
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Surgery General
90033
Keushkerian, Simon MD
1701 E Cesar E Chavez Ave
Ste 300
Los Angeles, CA 90033
(818) 242-6828
Provider ID: 204124
License: A44451
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: Yes
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 13change
www.blueshieldca.com/promise/calmediconnect
-
90012
LOS ANGELES COUNTY MEDICAL GROUPS ALTAMED - MONTEREY PARK
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Surgery Orthopedic
Cho, Yung MD
711 W College St Ste 625
Los Angeles, CA 90012
(562) 654-6899
Provider ID: 264829
License: A46321
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Korean,
Portuguese, Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
Special Expertise: Deafness or
Hard-of-Hearing, Co-occuring
Disorders
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Surgery Thoracic
90033
Nucho, Ramsay MD
1701 E Cesar E Chavez Ave
Ste 300
Los Angeles, CA 90033
(818) 242-6828
Provider ID: 209698
License: C41229
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: Yes
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 14change
www.blueshieldca.com/promise/calmediconnect
-
91706
LOS ANGELES COUNTY MEDICAL GROUPS ALTAMED HEALTH SERVICES CORPORATION
PRIMARY CARE PHYSICIANS
Family Practice
BALDWIN PARK
Urbina, Marvin MD
14342 Ramona Blvd
Baldwin Park, CA 91706
(626) 918-3828
Provider ID: 109128
License: A71133
Credentials and/or board
certification: No
Accepting New Members: No
Hours: M-SA 9AM-5PM
PTA: Yes
Other Language: Spanish,
Tagalog
Cultural Competency: NR
Accessibility: B, W; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
COVINA
91722
Mawaheb, Khaled MD
1433 N Hollenbeck Ave Ste
200
Covina, CA 91722
(626) 331-2209
Provider ID: 108777
License: A96423
Credentials and/or board
certification: No
Accepting New Members: No
Hours: M-SA 9AM-5PM
PTA: Yes
Other Language: Arabic,
Spanish, Tagalog
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
HUNTINGTON PARK
90255
Diaz, Daniel DO
1900 E Slauson Ave
Huntington Park, CA 90255
(888) 499-9303
Provider ID: 272187
License: 20A16032
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Liu, Qiji MD
1900 E Slauson Ave
Huntington Park, CA 90255
(888) 499-9303
Provider ID: 273049
License: A164724
Credentials and/or board
certification: No
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 15change
www.blueshieldca.com/promise/calmediconnect
-
90011
LOS ANGELES COUNTY MEDICAL GROUPS ALTAMED HEALTH SERVICES CORPORATION
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Japanese
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
LOS ANGELES
Chavez, Edgar MD
2801 S San Pedro St
Los Angeles, CA 90011
(323) 233-3100
Provider ID: 119444
License: A92965
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
90033
Madatovian, Harut DO
2928 E Cesar E Chavez Ave
Los Angeles, CA 90033
(626) 458-8401
Provider ID: 245423
License: 20A15143
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Armenian,
Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
90057
Zhou, Ann DO
2100 W 3rd St Ste 400
Los Angeles, CA 90057
(888) 499-9303
Provider ID: 273038
License: 20A18129
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
NORWALK
90650
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 16change
www.blueshieldca.com/promise/calmediconnect
-
90660
LOS ANGELES COUNTY MEDICAL GROUPS ALTAMED HEALTH SERVICES CORPORATION
Bejinez-eastman, Ana MD
13820 San Antonio Dr
Norwalk, CA 90650
(562) 908-4355
Provider ID: 240814
License: G67654
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
PICO RIVERA
Banerjee, Amit MD
9436 Slauson Ave
Pico Rivera, CA 90660
(888) 499-9303
Provider ID: 273082
License: A165446
Credentials and/or board
certification: No
Accepting New Members: No
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Bengali
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
SOUTH GATE
90280
Hernandez, Gerardo MD
8627 Atlantic Ave
South Gate, CA 90280
(888) 499-9303
Provider ID: 273065
License: A154073
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Madatovian, Harut DO
5831 Firestone Blvd Ste E
South Gate, CA 90280
(626) 458-8401
Provider ID: 245422
License: 20A15143
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Armenian,
Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
(*) CNP: Certified Nurse Practitioners NP: Nurse Practitioners PA: Physician Assistant CNM: Certified nurse
midwives CNS: Certified Nurse Specialists
Accessibility code explanations: P: Parking EB: Exterior Building IB: Interior Building R: Restroom E:Exam
Room T: Exam Table/Scale W: Wheelchair ME: Medical Equipment SR: Self reported: This information is
self-reported by the provider. Blue Shield Promise Cal Mediconnect Plan has not verified this information
PTA: Public Transportation Accessible within half a mile of provider site. Cultural Competency: CC : Cultural
Competency reported NR: Cultural Competency not reported. Interpreting services are available for all
providers through Blue Shield Promise Cal Mediconnect Plan at no cost. An advance notice is needed for
face-to- face and ASL interpreting services. To request services, contact Blue Shield Promise Cal
Mediconnect Plan Member Services. If you have questions, please call Blue Shield Promise Cal
Mediconnect at 1-855-905-3825 (TTY: 711), 8:00 a.m.– 8:00 p.m., seven days a week. The call is free. For
more information, visit www.blueshieldca.com/promise/calmediconnect. (**)Provides TeleServices Only
Call Member Services if you need information about a provider’s other credentials and/or certifications,
completion of cultural competence training, and/or areas of training and experience. This list is subject to 17change
www.blueshieldca.com/promise/calmediconnect
-
LOS ANGELES COUNTY MEDICAL GROUPS ALTAMED HEALTH SERVICES CORPORATION
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Morm, Lynnea DO
8627 Atlantic Ave
South Gate, CA 90280
(888) 499-9303
Provider ID: 273040
License: 20A15880
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.
Sandoval, Susana MD
8627 Atlantic Ave
South Gate, CA 90280
(888) 499-9303
Provider ID: 273045
License: A160706
Credentials and/or board
certification: No
Accepting New Members: Yes
Hours: M-SA 9AM-5PM
PTA: No
Other Language: Spanish
Cultural Competency: NR
Accessibility: B; Members
should call the provider’s
office to discuss their
accessibility needs when there
is limited access or when
accessibility indicators are not
present.
UPDATE: There was a change
in the provider record;
demographic, phone and/or
panel status.