Provider Demographics
NPI:1720536923
Name:JKC NEUROLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:JKC NEUROLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYUNG
Authorized Official - Middle Name:KU
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-487-3060
Mailing Address - Street 1:3550 WILSHIRE BLVD STE 650
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2440
Mailing Address - Country:US
Mailing Address - Phone:213-487-3060
Mailing Address - Fax:213-388-7168
Practice Address - Street 1:3550 WILSHIRE BLVD STE 650
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2440
Practice Address - Country:US
Practice Address - Phone:213-487-3060
Practice Address - Fax:213-388-7168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44986174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty