Healthcare Provider Details

I. General information

NPI: 1275739807
Provider Name (Legal Business Name): J H WELLS M D A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 ATLANTIC AVE SUITE 290
LONG BEACH CA
90806-1714
US

IV. Provider business mailing address

2880 ATLANTIC AVE STE 290
LONG BEACH CA
90806-1716
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-6543
  • Fax: 562-595-1414
Mailing address:
  • Phone: 562-595-6543
  • Fax: 562-595-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberC33481
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES H WELLS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-595-6543