Healthcare Provider Details

I. General information

NPI: 1174432389
Provider Name (Legal Business Name): IDOM INDUSTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 W OLYMPIC BLVD STE 1047
LOS ANGELES CA
90015-3876
US

IV. Provider business mailing address

14026 STARFLOWER CT
EASTVALE CA
92880-9076
US

V. Phone/Fax

Practice location:
  • Phone: 310-686-8828
  • Fax:
Mailing address:
  • Phone: 310-671-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DAWN BUNKLEY
Title or Position: ASW
Credential:
Phone: 213-545-7154