PROVIDENCE FOOT AND ANKLE CENTER, INC. (NPI# 1811253974) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811253974 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE FOOT AND ANKLE CENTER, INC. |
| Practice Address |
3130 W Olympic Blvd Suite 170 Los Angeles CA 90006-2484 |
| Mailing Address |
2980 N Beverly Glen Cir Suite 301 Los Angeles CA 90077-1726 |
| Practice Telephone | 3237327551 |
| Mailing Telephone | 3104749809 |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2012-04-03 |
| Authorized Official Name | DR. PETER S. PARK (CEO) |
| Authorized Official Telephone | 3237327551 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE FOOT AND ANKLE CENTER, INC. |
| Parent Organization TIN |
|
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | Suppliers |
| Street Address |
3130 W OLYMPIC BLVD SUITE 170 |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90006-2484 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285653808 | Stephen Sim | Podiatrist | 3130 W Olympic Blvd, Suite 170, Los Angeles, CA 90006-2484 | 2006-07-18 |
| 1447740493 | Varicose Relief Inc | Internal Medicine | 3130 W Olympic Blvd, Suite 360, Los Angeles, CA 90006-2484 | 2018-05-15 |
| 1952702458 | John C. Kang, Md, A Professional Corporation | Surgery | 3130 W Olympic Blvd, Suite 340, Los Angeles, CA 90006-2484 | 2014-09-16 |
| 1710281951 | Kwang Ho Lee | Hearing Instrument Specialist | 3130 W Olympic Blvd, Suite 290, Los Angeles, CA 90006-2484 | 2011-01-03 |
| 1720381635 | Alpha Rehab Center, Inc. | Physical Therapist | 3130 W Olympic Blvd, Ste 280, Los Angeles, CA 90006-2484 | 2010-12-15 |
| 1235453747 | Eunjoo Julie Park | Optometrist | 3130 W Olympic Blvd, Suite 105, Los Angeles, CA 90006-2484 | 2010-03-26 |
| 1851522254 | Providence Foot and Ankle Center | Clinic/Center | 3130 W Olympic Blvd, Suite 170, Los Angeles, CA 90006-2484 | 2009-08-03 |
| 1154557734 | La Lee Obgyn Medical Associate | Obstetrics & Gynecology | 3130 W Olympic Blvd, Suite 360, Los Angeles, CA 90006-2484 | 2009-06-09 |
| 1487802856 | Bok Nam Park | Dentist | 3130 W Olympic Blvd, #330, Los Angeles, CA 90006-2494 | 2008-08-28 |
| 1215115803 | Stephanie Kang | Occupational Therapist | 3130 W Olympic Blvd, Los Angeles, CA 90006-2484 | 2008-02-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114583549 | Ruahrena Corporation | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 3053 West Olympic Boulevard, Suite 301, Los Angeles, CA 90006 | 2019-05-10 |
| 1770048266 | Luxi Optometry, Inc | Ophthalmology | 3250 W. Olympic Blvd #221, Los Angeles, CA 90006 | 2019-02-08 |
| 1053895565 | Lili Mirtorabi D.d.s A Professional Corporation | Dentist | 2368 Pico Boulevard, Los Angeles, CA 90006 | 2018-09-20 |
| 1083192116 | Sanghee Hong | Nurse Practitioner | 2655 W Olympic Blvd Ste 101, Los Angeles, CA 90006 | 2018-07-31 |
| 1134638919 | Joon Hyung Kim | Chiropractor | 3130 W. Olympic Blvd., Suite 350, Los Angeles, CA 90006 | 2017-09-25 |
| 1578082988 | Judy Lee | Behavior Technician | 900 South Serrano Ave #401, Los Angeles, CA 90006 | 2017-09-18 |
| 1689126773 | Seungah Madison Lee | Acupuncturist | 3053 W. Olympic Blvd, #311, Los Angeles, CA 90006 | 2016-10-25 |
| 1790149789 | Kihyun Kim | Acupuncturist | 975 S. Vermont Ave, #201, Los Angeles, CA 90006 | 2016-04-06 |
| 1407215486 | Young Zoo Kim | Acupuncturist | 1001 S. Vermont Ave, #207, L.a., CA 90006 | 2016-02-18 |
| 1376916817 | Global Eastern Medicine Group | Acupuncturist | 1010 S. Fedora St. #101, Los Angeles, CA 90006 | 2015-11-05 |
| Find all providers in zip 90006 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730624719 | St. John's Well Child and Family Center Inc | Non-Pharmacy Dispensing Site | 326 W 23rd St, Los Angeles, CA 90007-2612 | 2016-12-29 |
| 1932395092 | Glenville Medical Group, A Medical Corporation | Non-Pharmacy Dispensing Site | 1531 Glenville Dr, Los Angeles, CA 90035-3107 | 2007-09-21 |
| 1265441216 | Randy L Peters | Non-Pharmacy Dispensing Site | 3198 W 7th St Apt 318, Los Angeles, CA 90005-1659 | 2006-08-07 |
| 1891245619 | Keith L. Gurnick, D.p.m. | Non-Pharmacy Dispensing Site | 2080 Century Park E, Suite 705, Los Angeles, CA 90067-2001 | 2016-10-04 |
| 1770962946 | R Roland Lopez, M.d., Inc. | Non-Pharmacy Dispensing Site | 1711 W Temple St, Suite 4100, Los Angeles, CA 90026-5421 | 2015-05-21 |
| 1386021475 | R Roland Lopez, M.d., Inc. | Non-Pharmacy Dispensing Site | 5301 Whittier Blvd, Suite B, Los Angeles, CA 90022-4038 | 2015-04-28 |
| 1033501101 | Ais Medical Foods, Inc. | Non-Pharmacy Dispensing Site | 8631 W 3rd St, Suite 1145e, Los Angeles, CA 90048-5901 | 2015-02-26 |
| 1255749099 | Morningside Primary Care Medical Center Mc Inc A Nevada Corporation | Non-Pharmacy Dispensing Site | 617 W Manchester Ave, Los Angeles, CA 90044-5718 | 2014-07-24 |
| 1386058402 | Arj Medical, Inc. | Non-Pharmacy Dispensing Site | 5655 E Beverly Blvd, Los Angeles, CA 90022-2803 | 2014-06-17 |
| 1043624489 | Daniel Capen, M.d., A Professional Corporation | Non-Pharmacy Dispensing Site | 6200 Wilshire Blvd, Suite 910, Los Angeles, CA 90048-5801 | 2014-06-13 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90006 |
Please comment or provide details below to improve the information on PROVIDENCE FOOT AND ANKLE CENTER, INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.