Provider Demographics
NPI:1013505452
Name:ELEMENT OF BLANK, INC.
Entity Type:Organization
Organization Name:ELEMENT OF BLANK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-954-6454
Mailing Address - Street 1:2001 SANTA MONICA BLVD STE 1280W
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2230
Mailing Address - Country:US
Mailing Address - Phone:310-904-6895
Mailing Address - Fax:310-882-7005
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 1280W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2230
Practice Address - Country:US
Practice Address - Phone:310-904-6895
Practice Address - Fax:310-882-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty