Provider Demographics
NPI:1609280346
Name:LOS ANGELES COMMUNITY CLINIC, INC.
Entity Type:Organization
Organization Name:LOS ANGELES COMMUNITY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:S
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-852-3245
Mailing Address - Street 1:1830 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3734
Mailing Address - Country:US
Mailing Address - Phone:323-852-3245
Mailing Address - Fax:213-325-6618
Practice Address - Street 1:1830 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 124
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-3734
Practice Address - Country:US
Practice Address - Phone:213-383-1183
Practice Address - Fax:213-383-1184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health