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General NPI Number Information
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NPI Number | 1285704254
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Entity Type | Organization
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Legal Business Name | J. CHANBONPIN, M.D., INC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 235 N HOOVER ST
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City | LOS ANGELES
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State | CA
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Zip | 90004-3627
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Country | US
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Telephone | 213-382-7252
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Fax |
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Provider Business Mailing Address
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Address Line | 1654 S EL MOLINO AVE
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City | SAN MARINO
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State | CA
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Zip | 91108-1701
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Country | US
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Telephone | 323-550-8285
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JIMMY CHANBONPIN
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Credential | M.D.
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Telephone | 213-382-7252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A39381
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License Number State | CA
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