MEDICARE: BARNNY JEPP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	930001008	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548231608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARNNY JEPP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 749127
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-9127
Country	:	US
Telephone Number	:	562-495-8075
Fax Number	:	562-495-8076

Provider Business Practice Location Address
First Line	:	1400 S GRAND AVE
Second Line	:	STE 105
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3048
Country	:	US
Telephone Number	:	213-867-1111
Fax Number	:	213-867-1117

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	THOMAS L. WEINBERG
Credential	:
Telephone Number	:	214-736-2700

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	11/14/2014

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