NPIMap

Organization Active NPI

Evergreen Wellness Center Inc.

  • Health Maintenance Organization
  • Los Angeles, CA
National Provider Identifier
1023295276
Registry record updated Nov 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
AC9278 Issued in CA
Legal business name
EVERGREEN WELLNESS CENTER INC.
Practice address
2950 Los Feliz Blvd
203
Los Angeles, CA 90039-1532
Phone
(323) 665-1985
NPI assigned
Jan 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joan Kim-Wagner, ACUPUNCTURIST
Title
President
Phone
(323) 665-1985

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X AC9278 CA Primary

Addresses

Primary practice location

2950 Los Feliz Blvd
203
Los Angeles, CA 90039-1532

Mailing address

2950 Los Feliz Blvd
203
Los Angeles, CA 90039-1532
Phone (323) 665-1985

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477958400000",
    "number": "1023295276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2950 LOS FELIZ BLVD",
            "address_2": "203",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900391532",
            "telephone_number": "323-665-1985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2950 LOS FELIZ BLVD",
            "address_2": "203",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900391532",
            "telephone_number": "323-665-1985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN WELLNESS CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-29",
        "last_updated": "2016-11-01",
        "status": "A",
        "authorized_official_last_name": "KIM-WAGNER",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-665-1985",
        "authorized_official_credential": "ACUPUNCTURIST"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "CA",
            "license": "AC9278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.