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General NPI Number Information
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NPI Number | 1184029712
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Entity Type | Organization
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Legal Business Name | CHARLIE SAM NEPHROLOGY
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 505 S VIRGIL AVE STE 301
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City | LOS ANGELES
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State | CA
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Zip | 90020-1443
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Country | US
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Telephone | 213-674-8282
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Fax | 213-232-7013
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Provider Business Mailing Address
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Address Line | 505 S. VIRGIL AVE. SUITE 301
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City | LOS ANGELES
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State | CA
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Zip | 90020
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Country | US
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Telephone | 213-674-8282
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Fax | 213-232-7013
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES CHO
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Credential | M.D.
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Telephone | 213-674-8282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | CA
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