MEDICARE: GENSTAR CLINICAL INC

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	261QE0800X	Endoscopy Clinic/Center
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1639876394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENSTAR CLINICAL INC

Provider Business Mailing Address
First Line	:	5225 WILSHIRE BLVD STE 1111
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4355
Country	:	US
Telephone Number	:	310-633-3310
Fax Number	:

Provider Business Practice Location Address
First Line	:	5225 WILSHIRE BLVD STE 1111
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4355
Country	:	US
Telephone Number	:	310-633-3310
Fax Number	:

Authorized Official
Title or Position	:	COMPLIANCE
Name	:	STAR CHOY
Credential	:
Telephone Number	:	650-483-9547

Provider Enumeration Date	:	02/13/2023
Last Update Date	:	01/17/2024

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Directions to “GENSTAR CLINICAL INC ” Practice Location

Language	Start Address	Practice Location

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