NPIMap

Organization Active NPI

Martin Luther King Jr. Multiservice Ambulatory Care Center

  • Clinic Pharmacy
  • Los Angeles, CA
National Provider Identifier
1629215504
Registry record updated Jan 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
PHE 14221 Issued in CA
Legal business name
MARTIN LUTHER KING JR. MULTISERVICE AMBULATORY CARE CENTER
Practice address
12021 Wilmington Ave
Room# B068
Los Angeles, CA 90059-3019
Phone
(310) 668-3966
NPI assigned
Jan 14, 2009
Last updated
Jan 14, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2009

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

Authorized official

Name
Ms. Carolyn S. Clark
Title
Ceo
Phone
(310) 668-5201

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X PHE 14221 CA Primary

Addresses

Primary practice location

12021 Wilmington Ave
Room# B068
Los Angeles, CA 90059-3019

Mailing address

12021 Wilmington Ave
Los Angeles, CA 90059-3019
Phone (310) 668-4321

National Provider Directory

National Provider Directory
Tax ID family
Hudson Health Center613 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

12021 Wilmington Ave
Rm B68
Los Angeles, CA 90059
Phone (310) 668-3966

NPI Registry JSON

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

{
    "created_epoch": "1231891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231891200000",
    "number": "1629215504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12021 WILMINGTON AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593019",
            "telephone_number": "310-668-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12021 WILMINGTON AVE",
            "address_2": "ROOM# B068",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593019",
            "telephone_number": "310-668-3966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN LUTHER KING JR. MULTISERVICE AMBULATORY CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-14",
        "last_updated": "2009-01-14",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-668-5201",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "CA",
            "license": "PHE 14221",
            "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 Jan 14, 2009; 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.