MEDICARE: SUNSET WALK-IN HEALTHCARE & OCCUPATIONAL MEDICINE CLINIC, PC

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	261QU0200X	Urgent Care Clinic/Center	G66088	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51939	OTHER	CA	DME PTAN

General Provider Information

NPI Number	:	1861747495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSET WALK-IN HEALTHCARE & OCCUPATIONAL MEDICINE CLINIC, PC

Provider Business Mailing Address
First Line	:	9201 W SUNSET BLVD STE M155
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-3700
Country	:	US
Telephone Number	:	310-273-1155
Fax Number	:

Provider Business Practice Location Address
First Line	:	9201 W SUNSET BLVD STE M155
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-3700
Country	:	US
Telephone Number	:	310-273-1155
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN CURTIS FOSTER
Credential	:	M.D.
Telephone Number	:	310-273-1155

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	08/10/2016

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