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General NPI Number Information
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NPI Number | 1952261968
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Entity Type | Organization
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Legal Business Name | GLENN PSYCHIATRIC MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/12/2025
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 2200 PACIFIC COAST HWY STE 103
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-2700
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Country | US
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Telephone | 424-728-5564
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Fax | 424-377-6548
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Provider Business Mailing Address
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Address Line | 2200 PACIFIC COAST HWY STE 103
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-2700
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Country | US
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Telephone | 424-728-5564
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Fax | 424-377-6548
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DYANA KO
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Credential | NP
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Telephone | 424-728-5564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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