Healthcare Provider Details

I. General information

NPI: 1659597037
Provider Name (Legal Business Name): RUSSIAN JEWISH COMMUNITY CULTURAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7636 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90046
US

IV. Provider business mailing address

7636 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90046-6409
US

V. Phone/Fax

Practice location:
  • Phone: 323-650-8118
  • Fax: 323-650-8504
Mailing address:
  • Phone: 323-650-8118
  • Fax: 323-650-8504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number060000804
License Number StateCA

VIII. Authorized Official

Name: VLADIMIR TSIKMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 323-656-8118