Eunice Jenny Bodak, HCPD

Primary specialty

Adult CompanionTaxonomy code 372600000X

License

522662 Issued in CA

Practice address

1220 5TH Ave
Los Angeles, CA 90019-3445

Phone

(310) 780-7697

Fax

(310) 371-1249

NPI assigned

Jul 30, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Global Breakthrough Mission

  • Adult Care Home Facility
  • Los Angeles, CA
  • NPI 1689561979
  NPD Authorized official

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

{
    "created_epoch": "1280448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444262400000",
    "number": "1184938375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 ARTESIA BLVD UNIT 117",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902783392",
            "telephone_number": "310-780-7697",
            "fax_number": "310-371-1249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 5TH AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900193445",
            "telephone_number": "310-780-7697",
            "fax_number": "310-371-1249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODAK",
        "first_name": "EUNICE",
        "middle_name": "JENNY",
        "name_prefix": "Mrs.",
        "credential": "HCPD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-30",
        "last_updated": "2015-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": "CA",
            "license": "522662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "372600000X",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bock Jung Kim DDS Inc
• Amber Bock
• Naomi Bock, PHD
• David Moi Bockari
• Sandra Boctor
• Lillian Jean Bodane, RD
• Jacob Isaiah Bodden, MD
• Jessica Lynne Bodden, MD
• Kenneth William Boddie, M.D.
• Madhav R Boddula, M.D., M.P.H.

• Adult Companion in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Adult Companion in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2015; 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.