Healthcare Provider Details

I. General information

NPI: 1306024179
Provider Name (Legal Business Name): WELLNESS CENTER AT CENTURY CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E SUITE 807
LOS ANGELES CA
90067-2001
US

IV. Provider business mailing address

2080 CENTURY PARK E SUITE 807
LOS ANGELES CA
90067-2001
US

V. Phone/Fax

Practice location:
  • Phone: 310-553-6494
  • Fax: 310-228-1030
Mailing address:
  • Phone: 310-553-6494
  • Fax: 310-228-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA60860
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA60860
License Number StateCA

VIII. Authorized Official

Name: DR. JESSICA J CHO
Title or Position: OWNER
Credential: M.D.
Phone: 310-553-6494