Healthcare Provider Details

I. General information

NPI: 1932857448
Provider Name (Legal Business Name): GENORA HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 HUNTINGTON DR S
LOS ANGELES CA
90032-1945
US

IV. Provider business mailing address

4880 HUNTINGTON DR S
LOS ANGELES CA
90032-1945
US

V. Phone/Fax

Practice location:
  • Phone: 713-409-7310
  • Fax:
Mailing address:
  • Phone: 713-409-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SU CHEN
Title or Position: OWNER
Credential: MD
Phone: 713-409-7310