| California Gerontology Clinic | |
|
1042 S Kingsley Dr Ste 3 Los Angeles CA 90006-2408 | |
| (213) 340-4799 | |
| (703) 662-6165 |
| Full Name | California Gerontology Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 1042 S Kingsley Dr Ste 3, Los Angeles, California |
| Authorized Official Name and Position | Jiho Choi (OWNER) |
| Authorized Official Contact | 2133404799 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| California Gerontology Clinic 4216 Evergreen Ln Ste 121 Annandale VA 22003-3256 Ph: (213) 340-4799 | California Gerontology Clinic 1042 S Kingsley Dr Ste 3 Los Angeles CA 90006-2408 Ph: (213) 340-4799 |
| NPI Number | 1073135406 |
|---|---|
| Provider Enumeration Date | 05/07/2020 |
| Last Update Date | 08/14/2020 |
| Medicare PECOS PAC ID | 6305268178 |
|---|---|
| Medicare Enrollment ID | O20200624001383 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073135406 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Jiho Choi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225149859 PECOS PAC ID: 8820097637 Enrollment ID: I20200925002647 |
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