MEDICARE: EJC TRANSPORT 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1649955964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EJC TRANSPORT LLC

Provider Business Mailing Address
First Line	:	2268 W 20TH ST APT 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-1412
Country	:	US
Telephone Number	:	213-291-4840
Fax Number	:

Provider Business Practice Location Address
First Line	:	2268 W 20TH ST APT 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-1412
Country	:	US
Telephone Number	:	213-291-4840
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SE CHO
Credential	:
Telephone Number	:	213-291-4840

Provider Enumeration Date	:	06/15/2023
Last Update Date	:	06/15/2023

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Directions to “EJC TRANSPORT LLC ” Practice Location

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