Provider Demographics
NPI:1093285918
Name:BE WELL CENTERS OF SOUTHERN CALIFORNIA, INC.
Entity Type:Organization
Organization Name:BE WELL CENTERS OF SOUTHERN CALIFORNIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SUNGHO
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-987-0431
Mailing Address - Street 1:5073 CENTRAL AVE UNIT 1646
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91908-1646
Mailing Address - Country:US
Mailing Address - Phone:760-987-0431
Mailing Address - Fax:
Practice Address - Street 1:7801 CENTER AVE STE 103
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-9112
Practice Address - Country:US
Practice Address - Phone:714-230-2440
Practice Address - Fax:714-230-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty