Healthcare Provider Details

I. General information

NPI: 1073855011
Provider Name (Legal Business Name): MWE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2013
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD PENTHOUSE
BEVERLY HILLS CA
90211-3121
US

IV. Provider business mailing address

409 N PACIFIC COAST HWY #448
REDONDO BEACH CA
90277-2870
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-0085
  • Fax: 866-390-0007
Mailing address:
  • Phone: 310-652-0085
  • Fax: 866-390-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAURY-YING KHON
Title or Position: PRESIDENT
Credential:
Phone: 424-234-1519