Provider Demographics
NPI:1164518122
Name:CHILDREN'S HEART RHYTHM INSTITUTE, MED. CORP.
Entity Type:Organization
Organization Name:CHILDREN'S HEART RHYTHM INSTITUTE, MED. CORP.
Other - Org Name:CHRI, MED CORP
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSELYN
Authorized Official - Middle Name:CARMEL
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-479-3147
Mailing Address - Street 1:PO BOX 24854
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-0854
Mailing Address - Country:US
Mailing Address - Phone:310-869-8590
Mailing Address - Fax:310-479-3147
Practice Address - Street 1:3740 ATLANTIC AVE STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3440
Practice Address - Country:US
Practice Address - Phone:310-869-8590
Practice Address - Fax:310-479-3147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG071856208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G71856OtherMEDI-CAL PIN