Provider Demographics
NPI:1073135406
Name:CALIFORNIA GERONTOLOGY CLINIC
Entity Type:Organization
Organization Name:CALIFORNIA GERONTOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIHO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-340-4799
Mailing Address - Street 1:4216 EVERGREEN LN STE 121
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3256
Mailing Address - Country:US
Mailing Address - Phone:213-340-4799
Mailing Address - Fax:703-662-6165
Practice Address - Street 1:1042 S KINGSLEY DR STE 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2408
Practice Address - Country:US
Practice Address - Phone:213-340-4799
Practice Address - Fax:703-662-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty