Provider Demographics
NPI:1942591847
Name:JONAH MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:JONAH MEDICAL GROUP, INC.
Other - Org Name:NANOOM MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-821-5675
Mailing Address - Street 1:866 S. WESTMORELAND AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005
Mailing Address - Country:US
Mailing Address - Phone:800-821-5675
Mailing Address - Fax:213-289-1166
Practice Address - Street 1:866 S. WESTMORELAND AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005
Practice Address - Country:US
Practice Address - Phone:800-821-5675
Practice Address - Fax:213-289-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA54943OtherCALIFORNIA LICENSE
CAA54943OtherCALIFORNIA LICENSE
CAH44052Medicare UPIN
CAWA54943CMedicaid