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General NPI Number Information
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NPI Number | 1457082794
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Entity Type | Organization
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Legal Business Name | ENHANCED CARE RX CLINIC, INC.
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 266 S HARVARD BLVD STE 120A
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City | LOS ANGELES
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State | CA
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Zip | 90004-4374
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Country | US
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Telephone | 213-527-2995
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Fax | 213-527-2996
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Provider Business Mailing Address
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Address Line | PO BOX 741330
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City | LOS ANGELES
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State | CA
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Zip | 90004-9330
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Country | US
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Telephone | 213-527-2995
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Fax | 213-527-2996
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Authorized Official
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Title or Position | CEO
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Name | SANG JUNG LEE
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Credential |
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Telephone | 213-527-2995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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