Provider Demographics
NPI:1174845556
Name:VENICE HEALTH CENTER
Entity Type:Organization
Organization Name:VENICE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JINYOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-616-8780
Mailing Address - Street 1:730 S WESTERN AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-5901
Mailing Address - Country:US
Mailing Address - Phone:951-616-8780
Mailing Address - Fax:323-208-4812
Practice Address - Street 1:730 S WESTERN AVE #208
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-5901
Practice Address - Country:US
Practice Address - Phone:951-616-8780
Practice Address - Fax:323-208-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13069171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty