Healthcare Provider Details

I. General information

NPI: 1487040945
Provider Name (Legal Business Name): ANDREA POON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2015
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ STE 3325
LOS ANGELES CA
90095-1519
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-8946
  • Fax: 310-267-3899
Mailing address:
  • Phone: 310-301-8707
  • Fax: 310-307-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA146506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: