Healthcare Provider Details

I. General information

NPI: 1366372781
Provider Name (Legal Business Name): AWAKENING MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12470 W WASHINGTON BLVD
LOS ANGELES CA
90066-5512
US

IV. Provider business mailing address

12470 W WASHINGTON BLVD
LOS ANGELES CA
90066-5512
US

V. Phone/Fax

Practice location:
  • Phone: 323-696-0207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JASVINDER SINGH BAWA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 404-808-8114