Healthcare Provider Details

I. General information

NPI: 1689585663
Provider Name (Legal Business Name): AGAPE MEDICAL GROUP WEST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 WILSHIRE BLVD
BEVERLY HILLS CA
90212-2021
US

IV. Provider business mailing address

1301 N BROADWAY STE 32260
LOS ANGELES CA
90012-1408
US

V. Phone/Fax

Practice location:
  • Phone: 310-466-0490
  • Fax: 323-524-1691
Mailing address:
  • Phone: 310-466-0490
  • Fax: 323-524-1691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: BAILEY RENGER
Title or Position: ORGANIZATION ADMINISTRATOR
Credential:
Phone: 973-943-0967