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MARTIN LUTHER KING JR COMMUNITY MEDICAL GROUP WILMINGTON AVE NPI 1639704323


NPI Information

NPI: 1639704323
Provider Name: MARTIN LUTHER KING JR COMMUNITY MEDICAL GROUP WILMINGTON AVE
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 05D2178260

Address:
12021 WILMINGTON AVE
BUILDING 11, SUITE 1000
LOS ANGELES, CA
ZIP 90059
Phone: (424) 529-6755
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MARTIN LUTHER KING JR COMMUNITY MEDICAL GROUP WILMINGTON AVE is an internal medicine in Los Angeles, CA. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. MARTIN LUTHER KING JR COMMUNITY MEDICAL GROUP WILMINGTON AVE NPI is 1639704323. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

12021 WILMINGTON AVE
BUILDING 11, SUITE 1000
LOS ANGELES, CA
ZIP 90059
Phone: (424) 529-6755
Fax: (424) 338-8984

The provider's authorized official is Kurt Stauder .
The authorized official title is President and has the following contact phone number (424) 529-6755.

The CLIA number assigned to this NPI record is 05D2178260 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/3/2020 and was last updated on 12/12/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1171M00000XCase Manager/Care CoordinatorNo
2171R00000XInterpreterNo
3172V00000XCommunity Health WorkerNo
4207QA0401XFamily MedicineAddiction MedicineNo
5207QA0505XFamily MedicineAdult MedicineNo
6207RC0000XInternal MedicineCardiovascular DiseaseNo
7207RP1001XInternal MedicinePulmonary DiseaseNo
8207R00000XInternal MedicineYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.