Provider Demographics
NPI:1689780975
Name:MIGHTY FIRE MEDICAL CENTER
Entity Type:Organization
Organization Name:MIGHTY FIRE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OWUSU
Authorized Official - Middle Name:
Authorized Official - Last Name:FIREMPONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-541-9299
Mailing Address - Street 1:311 N ROBERTSON BLVD # 373
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5321 S NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-3411
Practice Address - Country:US
Practice Address - Phone:323-541-9299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG42397FMedicare ID - Type UnspecifiedMEDICARE ID