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General NPI Number Information
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NPI Number | 1689780975
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Entity Type | Organization
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Legal Business Name | MIGHTY FIRE MEDICAL CENTER
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5321 S NORMANDIE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90037-3411
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Country | US
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Telephone | 323-541-9299
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Fax |
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Provider Business Mailing Address
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Address Line | 311 N ROBERTSON BLVD # 373
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1705
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Country | US
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Telephone |
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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. OWUSU FIREMPONG
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Credential | M.D.
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Telephone | 323-541-9299
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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 |
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License Number State |
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