Provider Demographics
NPI:1780013474
Name:AJU HEALTH AND WELLNESS SPECIALISTS A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:AJU HEALTH AND WELLNESS SPECIALISTS A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:213-383-0007
Mailing Address - Street 1:2560 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2998
Mailing Address - Country:US
Mailing Address - Phone:213-383-0007
Mailing Address - Fax:
Practice Address - Street 1:2560 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2998
Practice Address - Country:US
Practice Address - Phone:213-383-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12170111N00000X
CAC32413208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty