Fomukong Health Foundation INC
Preferred Provider Organization in Los Angeles, CA. Organization (NPI-2).
NPI number1861732190
StatusActive
Last updated in NPPESFeb 23, 2013
Details
- NPI
- 1861732190
- Entity type
- Organization (NPI-2)
- Legal business name
- Fomukong Health Foundation INC
- Organization subpart
- No
- Enumeration date
- Feb 23, 2013
- Last updated
- Feb 23, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 305R00000X | Preferred Provider Organization | 2768722 | CA | Yes |
Practice location
2355 Westwood Blvd # 332Los Angeles, CA 90064-2109
Phone 310-701-6703
Mailing address
2355 Westwood Blvd # 332Los Angeles, CA 90064-2109
Phone 310-701-6703
Authorized official
Ndika Fomukong
Chief Executive Officer
3107016703
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