Provider Demographics
NPI:1629795521
Name:MARTIN LUTHER KING JR COMMUNITY MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:MARTIN LUTHER KING JR COMMUNITY MEDICAL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-529-6755
Mailing Address - Street 1:2215 W ROSECRANS AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-3856
Mailing Address - Country:US
Mailing Address - Phone:424-529-6755
Mailing Address - Fax:424-338-8984
Practice Address - Street 1:2215 W ROSECRANS AVE STE 22
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-3856
Practice Address - Country:US
Practice Address - Phone:424-529-6755
Practice Address - Fax:424-338-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty