Healthcare Provider Details

I. General information

NPI: 1265530653
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL LOS ANGELES MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 SUNSET BLVD
LOS ANGELES CA
90027
US

IV. Provider business mailing address

3250 WILSHIRE BLVD STE 1101
LOS ANGELES CA
90010-1513
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2337
  • Fax: 323-361-8491
Mailing address:
  • Phone: 323-361-2337
  • Fax: 323-361-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES LIN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 323-361-1601