| Avantis Neuroscience Inc | |
|
12401 Wilshire Blvd Ste 104 Los Angeles CA 90025-1015 | |
| (323) 682-0182 | |
| Not Available |
| Full Name | Avantis Neuroscience Inc |
|---|---|
| Speciality | Psychiatry & Neurology - Clinical Neurophysiology |
| Location | 12401 Wilshire Blvd Ste 104, Los Angeles, California |
| Authorized Official Name and Position | Jeffrey M Chung (CEO) |
| Authorized Official Contact | 3236820182 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Avantis Neuroscience Inc 1807 Wilshire Blvd Ste A Santa Monica CA 90403-5678 Ph: () - | Avantis Neuroscience Inc 12401 Wilshire Blvd Ste 104 Los Angeles CA 90025-1015 Ph: (323) 682-0182 |
| NPI Number | 1396278321 |
|---|---|
| Provider Enumeration Date | 04/06/2017 |
| Last Update Date | 01/23/2020 |
| Certification Date | 01/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396278321 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | (* (Not Available)) | Primary |
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