Healthcare Provider Details

I. General information

NPI: 1326829367
Provider Name (Legal Business Name): NOHO MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12805 VICTORY BLVD
NORTH HOLLYWOOD CA
91606-3012
US

IV. Provider business mailing address

12805 VICTORY BLVD
NORTH HOLLYWOOD CA
91606-3012
US

V. Phone/Fax

Practice location:
  • Phone: 213-293-2323
  • Fax: 213-290-9191
Mailing address:
  • Phone: 213-293-2323
  • Fax: 213-290-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. EDWARD NANA OPOKU JR.
Title or Position: CEO
Credential: MD
Phone: 323-974-3211