Healthcare Provider Details

I. General information

NPI: 1093850752
Provider Name (Legal Business Name): LA COUNTY KING DREW MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 WILMINGTON AVE
LOS ANGELES CA
90059-3019
US

IV. Provider business mailing address

10142 BIRCHWOOD DR
HUNTINGTON BEACH CA
92646-5433
US

V. Phone/Fax

Practice location:
  • Phone: 310-668-4611
  • Fax:
Mailing address:
  • Phone: 714-968-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NW0100X
TaxonomyWomen's Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROBABEH AKHAVAN AZARI
Title or Position: CNM
Credential:
Phone: 310-668-4611