Healthcare Provider Details

I. General information

NPI: 1336044395
Provider Name (Legal Business Name): MERIDIAN CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 AVENUE OF THE STARS # 248
LOS ANGELES CA
90067-6001
US

IV. Provider business mailing address

1901 AVENUE OF THE STARS # 248
LOS ANGELES CA
90067-6001
US

V. Phone/Fax

Practice location:
  • Phone: 747-369-8381
  • Fax:
Mailing address:
  • Phone: 747-369-8381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: TEERAPAT SUSHEWAKHUL
Title or Position: CEO
Credential:
Phone: 747-369-8381