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General NPI Number Information
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NPI Number | 1780133991
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Entity Type | Organization
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Legal Business Name | HOUSE OF GOOD NEIGHBOR MISSION CENTER
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Dates
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Enumeration Date | 09/28/2016
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 900 S WESTMORELAND AVE STE #206
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City | LOS ANGELES
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State | CA
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Zip | 90006-5645
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Country | US
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Telephone | 213-384-7078
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Fax |
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Provider Business Mailing Address
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Address Line | 900 S WESTMORELAND AVE STE #206
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City | LOS ANGELES
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State | CA
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Zip | 90006-5645
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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 | CEO
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Name | DR. YOUNG KIM
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Credential | D.D.S.
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Telephone | 714-397-9444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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