Healthcare Provider Details

I. General information

NPI: 1538596457
Provider Name (Legal Business Name): AJU MEDICAL AND WELLNESS CENTER A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 W OLYMPIC BLVD SUITE 205
LOS ANGELES CA
90006-2998
US

IV. Provider business mailing address

2560 W OLYMPIC BLVD SUITE 205
LOS ANGELES CA
90006-2998
US

V. Phone/Fax

Practice location:
  • Phone: 213-999-7770
  • Fax: 866-505-1544
Mailing address:
  • Phone: 213-999-7770
  • Fax: 866-505-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NELSON LEE
Title or Position: PRESIDENT
Credential: DC
Phone: 213-383-0007