Provider Demographics
NPI:1750575916
Name:FARFALLA INC.
Entity type:Organization
Organization Name:FARFALLA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HUI JU
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-383-5388
Mailing Address - Street 1:1236 CHELSEA AVE
Mailing Address - Street 2:#1
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1461
Mailing Address - Country:US
Mailing Address - Phone:310-383-5388
Mailing Address - Fax:
Practice Address - Street 1:3655 LOMITA BLVD
Practice Address - Street 2:#211
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3931
Practice Address - Country:US
Practice Address - Phone:310-383-5388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6809261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care