Provider Demographics
NPI:1881131589
Name:LAURI I. AN
Entity type:Organization
Organization Name:LAURI I. AN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:I
Authorized Official - Last Name:AN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-388-7887
Mailing Address - Street 1:2655 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2800
Mailing Address - Country:US
Mailing Address - Phone:213-388-7887
Mailing Address - Fax:213-388-3504
Practice Address - Street 1:2655 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2800
Practice Address - Country:US
Practice Address - Phone:213-388-7887
Practice Address - Fax:213-388-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42565261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE27242Medicare UPIN