Healthcare Provider Details

I. General information

NPI: 1457082794
Provider Name (Legal Business Name): ENHANCED CARE RX CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 S HARVARD BLVD STE 120A
LOS ANGELES CA
90004-4374
US

IV. Provider business mailing address

PO BOX 741330
LOS ANGELES CA
90004-9330
US

V. Phone/Fax

Practice location:
  • Phone: 213-527-2995
  • Fax: 213-527-2996
Mailing address:
  • Phone: 213-527-2995
  • Fax: 213-527-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANG JUNG LEE
Title or Position: CEO
Credential:
Phone: 213-527-2995