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General NPI Number Information
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NPI Number | 1457173023
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Entity Type | Organization
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Legal Business Name | MLK OPCO, LLC
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 12021 WILMINGTON AVE # 5-C
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City | LOS ANGELES
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State | CA
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Zip | 90059-3019
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Country | US
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Telephone | 310-730-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 9526 W PICO BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-1202
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Country | US
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Telephone | 213-812-5258
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Fax |
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | JAI CHUNG
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Credential | ESQ
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Telephone | 213-812-5258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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