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

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

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

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II

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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

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

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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.