Revitalife Medical Center

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

REVITALIFE MEDICAL CENTER

Doing business as

Revitalife Medical Center

Practice address

14650 Aviation Blvd
Hawthorne, CA 90250-6668

Phone

(310) 545-1154

Fax

(310) 545-1132

NPI assigned

Apr 3, 2024

Organization subpart

No

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

Authorized official

Name

Khoi Vu

Title

MD

Phone

(310) 545-1154

Specialties & licenses 1

Addresses

Other names 1

• Revitalife Medical Center Doing business as

Locations

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

{
    "created_epoch": "1712102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1912759820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14650 AVIATION BLVD",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902506668",
            "telephone_number": "310-545-1154",
            "fax_number": "310-545-1132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14650 AVIATION BLVD",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902506668",
            "telephone_number": "310-545-1154",
            "fax_number": "310-545-1132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIFE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-03",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "VU",
        "authorized_official_first_name": "KHOI",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "310-545-1154"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revitalife Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Karina Reyes
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• Rudy Richard
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• Family Medicine Physician in Hawthorne, CA
• Providers in Hawthorne, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 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.