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General NPI Number Information
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NPI Number | 1235770553
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Entity Type | Organization
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Legal Business Name | JEM DYNAMICS INC
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 5176 SANTA MONICA BLVD STE 107
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City | LOS ANGELES
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State | CA
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Zip | 90029-2586
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Country | US
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Telephone | 323-407-6418
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Fax | 323-983-8796
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Provider Business Mailing Address
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Address Line | 1268 N HOBART BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90029-1110
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AKOP GAVADIAN
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Credential |
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Telephone | 323-407-6418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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