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General NPI Number Information
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NPI Number | 1992452551
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Entity Type | Organization
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Legal Business Name | REJUVV, P.C.
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Dates
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Enumeration Date | 03/03/2022
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 1101 N SEPULVEDA BLVD STE 202
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-5963
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Country | US
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Telephone | 310-980-8368
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Fax |
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Provider Business Mailing Address
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Address Line | 18119 PRAIRIE AVE
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City | TORRANCE
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State | CA
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Zip | 90504-3739
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Country | US
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Telephone | 310-980-8368
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARTHA KOO
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Credential | M.D.
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Telephone | 310-980-8368
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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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