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General NPI Number Information
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NPI Number | 1255548483
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Entity Type | Organization
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Legal Business Name | KEDREN COMMUNITY HEALTH CENTER, INC.
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 04/16/2019
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Provider Practice Location Address
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Address Line | 4211 SOUTH AVALON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90011
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Country | US
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Telephone | 323-432-5093
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Fax | 323-233-5015
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Provider Business Mailing Address
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Address Line | 4211 SOUTH AVALON BLVD.
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City | LOS ANGELES
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State | CA
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Zip | 90011-5622
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Country | US
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Telephone | 323-432-5093
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Fax | 323-233-5015
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Authorized Official
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Title or Position | CHIEF INFORMATION OFFICER
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Name | DR. EARLE CHARLES CHARLES
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Credential |
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Telephone | 323-432-5093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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