Healthcare Provider Details

I. General information

NPI: 1801938592
Provider Name (Legal Business Name): TOWN CENTER MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4082 WHITTIER BLVD SUITE 102
LOS ANGELES CA
90023-2558
US

IV. Provider business mailing address

4082 WHITTIER BLVD SUITE 102
LOS ANGELES CA
90023-2558
US

V. Phone/Fax

Practice location:
  • Phone: 323-265-0136
  • Fax:
Mailing address:
  • Phone: 323-265-0136
  • Fax: 626-265-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA38076
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK CHOI
Title or Position: OWNER DOCTOR
Credential: MD
Phone: 626-808-8765