Healthcare Provider Details

I. General information

NPI: 1932384682
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL LOS ANGELES MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

3250 WILSHIRE BLVD STE 1101
LOS ANGELES CA
90010-1513
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-5168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES LIN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 323-361-1601