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General NPI Number Information
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NPI Number | 1306142468
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Entity Type | Organization
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Legal Business Name | PATIMA LIFE MEDICAL GROUP,INC
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Dates
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Enumeration Date | 02/07/2011
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Last Update Date | 02/07/2011
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Provider Practice Location Address
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Address Line | 505 SHATTO PL 200
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City | LOS ANGELES
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State | CA
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Zip | 90020-1754
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Country | US
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Telephone | 213-736-0450
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Fax |
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Provider Business Mailing Address
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Address Line | 505 SHATTO PL 200
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City | LOS ANGELES
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State | CA
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Zip | 90020-1754
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Country | US
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Telephone | 213-736-0450
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | RICHARD CHUNG
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Credential |
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Telephone | 213-736-0450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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