Healthcare Provider Details

I. General information

NPI: 1851123780
Provider Name (Legal Business Name): INCINTA MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21545 HAWTHORNE BLVD # B
TORRANCE CA
90503-6609
US

IV. Provider business mailing address

21545 HAWTHORNE BLVD # B
TORRANCE CA
90503-6609
US

V. Phone/Fax

Practice location:
  • Phone: 424-212-4087
  • Fax: 424-212-4088
Mailing address:
  • Phone: 424-212-4087
  • Fax: 424-212-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: PROF. JINGTING LI
Title or Position: PRACTICE MANAGER
Credential:
Phone: 424-212-4087