Healthcare Provider Details

I. General information

NPI: 1720536923
Provider Name (Legal Business Name): JKC NEUROLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 WILSHIRE BLVD STE 650
LOS ANGELES CA
90010-2440
US

IV. Provider business mailing address

3550 WILSHIRE BLVD STE 650
LOS ANGELES CA
90010-2440
US

V. Phone/Fax

Practice location:
  • Phone: 213-487-3060
  • Fax: 213-388-7168
Mailing address:
  • Phone: 213-487-3060
  • Fax: 213-388-7168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA44986
License Number StateCA

VIII. Authorized Official

Name: DR. KYUNG KU CHO
Title or Position: PRESIDENT
Credential: M.D
Phone: 213-487-3060