| Charlie Sam Nephrology | |
|
505 S Virgil Ave Ste 301 Los Angeles CA 90020-1443 | |
| (213) 674-8282 | |
| (213) 232-7013 |
| Full Name | Charlie Sam Nephrology |
|---|---|
| Speciality | Clinic/Center |
| Location | 505 S Virgil Ave Ste 301, Los Angeles, California |
| Authorized Official Name and Position | Charles Cho (PRESIDENT) |
| Authorized Official Contact | 2136748282 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charlie Sam Nephrology 505 S. Virgil Ave. Suite 301 Los Angeles CA 90020 Ph: (213) 674-8282 | Charlie Sam Nephrology 505 S Virgil Ave Ste 301 Los Angeles CA 90020-1443 Ph: (213) 674-8282 |
| NPI Number | 1184029712 |
|---|---|
| Provider Enumeration Date | 10/24/2014 |
| Last Update Date | 10/24/2014 |
| Medicare PECOS PAC ID | 3971826496 |
|---|---|
| Medicare Enrollment ID | O20150108000008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184029712 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (California) | Primary |
| Provider Name | Charles Cho |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1053512566 PECOS PAC ID: 9830381821 Enrollment ID: I20150115000000 |
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