Longevita Clinic, a Professional Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

LONGEVITA CLINIC, A PROFESSIONAL CORPORATION

Practice address

21757 Devonshire St Ste 1
Chatsworth, CA 91311-2975

Phone

(805) 630-7149

Fax

(888) 981-8739

NPI assigned

Mar 9, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Richard Park, MD

Title

Secretary

Phone

(805) 368-1293

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1615248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677196800000",
    "number": "1730774076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21757 DEVONSHIRE ST STE 1",
            "city": "CHATSWORTH",
            "state": "CA",
            "postal_code": "913112975",
            "telephone_number": "818-678-9875",
            "fax_number": "747-200-2589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21757 DEVONSHIRE ST STE 1",
            "city": "CHATSWORTH",
            "state": "CA",
            "postal_code": "913112975",
            "telephone_number": "805-630-7149",
            "fax_number": "888-981-8739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITA CLINIC, A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-09",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "805-368-1293",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Chatsworth, CA
• Providers in Chatsworth, 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 Feb 24, 2023; 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.