Provider Demographics
NPI:1336309962
Name:FAMILY WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:FAMILY WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONG
Authorized Official - Middle Name:HWAN
Authorized Official - Last Name:KOO
Authorized Official - Suffix:
Authorized Official - Credentials:PYS D
Authorized Official - Phone:562-569-5580
Mailing Address - Street 1:18300 GRIDLEY RD
Mailing Address - Street 2:STE 304
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-5440
Mailing Address - Country:US
Mailing Address - Phone:562-569-5580
Mailing Address - Fax:562-924-3851
Practice Address - Street 1:18300 GRIDLEY RD
Practice Address - Street 2:STE 304
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-5440
Practice Address - Country:US
Practice Address - Phone:562-569-5580
Practice Address - Fax:562-924-3851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19860103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty