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General NPI Number Information
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NPI Number | 1760910210
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Entity Type | Organization
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Legal Business Name | SCULPT DTLA
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Dates
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Enumeration Date | 05/30/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 705 S OLIVE ST STE A
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City | LOS ANGELES
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State | CA
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Zip | 90014-2642
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Country | US
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Telephone | 951-202-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 705 S OLIVE ST STE A
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City | LOS ANGELES
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State | CA
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Zip | 90014-2642
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Country | US
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Telephone | 951-202-4100
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. BENNY HAU
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Credential | MD
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Telephone | 951-202-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G74902
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License Number State | CA
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