| Purpose Driven Mobile Physician | |
|
4221 Wilshire Blvd Ste 170-8 Los Angeles CA 90010-3519 | |
| (818) 646-7203 | |
| Not Available |
| Full Name | Purpose Driven Mobile Physician |
|---|---|
| Speciality | Family Medicine |
| Location | 4221 Wilshire Blvd Ste 170-8, Los Angeles, California |
| Authorized Official Name and Position | Philip Kim (CEO) |
| Authorized Official Contact | 2135984947 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Purpose Driven Mobile Physician 4221 Wilshire Blvd Ste 170-8 Los Angeles CA 90010-3519 Ph: () - | Purpose Driven Mobile Physician 4221 Wilshire Blvd Ste 170-8 Los Angeles CA 90010-3519 Ph: (818) 646-7203 |
| NPI Number | 1871365320 |
|---|---|
| Provider Enumeration Date | 10/27/2023 |
| Last Update Date | 10/27/2023 |
| Medicare PECOS PAC ID | 1557803673 |
|---|---|
| Medicare Enrollment ID | O20240604004306 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871365320 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| Provider Name | Jae S Chu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063400745 PECOS PAC ID: 6507981206 Enrollment ID: I20100918000098 |
| Provider Name | Sojung Suk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811376056 PECOS PAC ID: 1658674981 Enrollment ID: I20160120002722 |
| Provider Name | Heather Jo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376913319 PECOS PAC ID: 3274830161 Enrollment ID: I20160321000171 |
| Provider Name | Michele H Hwang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811407331 PECOS PAC ID: 6103346838 Enrollment ID: I20250225000737 |
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