Healthcare Provider Details

I. General information

NPI: 1639876394
Provider Name (Legal Business Name): GENSTAR CLINICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 WILSHIRE BLVD STE 1111
LOS ANGELES CA
90036-4355
US

IV. Provider business mailing address

5225 WILSHIRE BLVD STE 1111
LOS ANGELES CA
90036-4355
US

V. Phone/Fax

Practice location:
  • Phone: 310-633-3310
  • Fax:
Mailing address:
  • Phone: 310-633-3310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STAR CHOY
Title or Position: COMPLIANCE
Credential:
Phone: 650-483-9547