Provider Demographics
NPI:1790824886
Name:JANET MEDICAL CLINIC, INC
Entity Type:Organization
Organization Name:JANET MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINYERE
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:NYENKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-732-4224
Mailing Address - Street 1:1776 W ADAMS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-2704
Mailing Address - Country:US
Mailing Address - Phone:323-732-4224
Mailing Address - Fax:323-732-4234
Practice Address - Street 1:1776 W ADAMS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-2704
Practice Address - Country:US
Practice Address - Phone:323-732-4224
Practice Address - Fax:323-732-4234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0468736Medicaid
CAW19475Medicare ID - Type Unspecified
CA0468736Medicaid