Provider Demographics
NPI:1457082794
Name:ENHANCED CARE RX CLINIC, INC.
Entity Type:Organization
Organization Name:ENHANCED CARE RX CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANG JUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-527-2995
Mailing Address - Street 1:PO BOX 741330
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-9330
Mailing Address - Country:US
Mailing Address - Phone:213-527-2995
Mailing Address - Fax:213-527-2996
Practice Address - Street 1:266 S HARVARD BLVD STE 120A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-4374
Practice Address - Country:US
Practice Address - Phone:213-527-2995
Practice Address - Fax:213-527-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty