| NPI | 1164099792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATRINA LING Administrator 310-480-4556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2021-06-10 |