Healthcare Provider Details

I. General information

NPI: 1063451425
Provider Name (Legal Business Name): DAEHAN MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 CRENSHAW BLVD
LOS ANGELES CA
90019-1940
US

IV. Provider business mailing address

1053 CRENSHAW BLVD
LOS ANGELES CA
90019-1940
US

V. Phone/Fax

Practice location:
  • Phone: 323-933-2785
  • Fax:
Mailing address:
  • Phone: 323-933-2785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA77448
License Number StateCA

VIII. Authorized Official

Name: JOHN CHANG
Title or Position: DIRECTOR
Credential: MD
Phone: 323-933-2785