Provider Demographics
NPI:1538596457
Name:AJU MEDICAL AND WELLNESS CENTER A PROFESSIONAL CORP
Entity type:Organization
Organization Name:AJU MEDICAL AND WELLNESS CENTER A PROFESSIONAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:213-383-0007
Mailing Address - Street 1:2560 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2998
Mailing Address - Country:US
Mailing Address - Phone:213-999-7770
Mailing Address - Fax:866-505-1544
Practice Address - Street 1:2560 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2998
Practice Address - Country:US
Practice Address - Phone:213-999-7770
Practice Address - Fax:866-505-1544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty