Eden Health Medical of California PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

EDEN HEALTH MEDICAL OF CALIFORNIA PC

Practice address

4470 W Sunset Blvd
Los Angeles, CA 90027-6302

Phone

(917) 261-4414

NPI assigned

May 3, 2021

Organization subpart

No

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

Authorized official

Name

Donald Wayne Jenkins, MD

Title

President

Phone

(917) 261-4414

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1174106694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 GOODELL ST STE 510",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4470 W SUNSET BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276302",
            "telephone_number": "917-261-4414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "77 Goodell St Ste 510",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142031258",
            "country_code": "US",
            "telephone_number": "917-261-4414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EDEN HEALTH MEDICAL OF CALIFORNIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-03",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "917-261-4414",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Schulman Edelstein, LMFT, ATR, CDP
• Shawn Marie Edelstein, PA-C
• Susan Barbara Edelstein, MSW
• Jacob Joseph Edem
• Sarah Edem
• Darla Eden, MS/CC APCC
• Myra Santiago Eden, P.T.
• Naomi-Sara Eden, MSW, MPP
• Alison Eder, AMFT
• Alma Edeza Heredia

• Internal Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; 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.