Healthcare Provider Details

I. General information

NPI: 1164518122
Provider Name (Legal Business Name): CHILDREN'S HEART RHYTHM INSTITUTE, MED. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 ATLANTIC AVE STE 100
LONG BEACH CA
90807-3440
US

IV. Provider business mailing address

PO BOX 24854
LOS ANGELES CA
90024-0854
US

V. Phone/Fax

Practice location:
  • Phone: 310-869-8590
  • Fax: 310-479-3147
Mailing address:
  • Phone: 310-869-8590
  • Fax: 310-479-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG071856
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberG071856
License Number StateCA

VIII. Authorized Official

Name: DR. JOSELYN CARMEL LEE
Title or Position: DIRECTOR
Credential: M.D.
Phone: 310-479-3147