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General NPI Number Information
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NPI Number | 1316763097
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Entity Type | Organization
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Legal Business Name | 1818 WESTERN LLC
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 1818 S WESTERN AVE STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90006-5862
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Country | US
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Telephone | 805-558-6138
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Fax |
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Provider Business Mailing Address
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Address Line | 1818 S WESTERN AVE STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90006-5862
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Country | US
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Telephone | 805-558-6138
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Fax |
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Authorized Official
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Title or Position | CEO & PRESIDENT
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Name | DAVID S KO
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Credential |
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Telephone | 818-438-8211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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