Provider Demographics
NPI:1548099807
Name:ILUNGA, JONATHAN KALENGAYI
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:KALENGAYI
Last Name:ILUNGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 N HUDSON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-2535
Mailing Address - Country:US
Mailing Address - Phone:213-570-6620
Mailing Address - Fax:
Practice Address - Street 1:1483 HAVENHURST DR
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-3814
Practice Address - Country:US
Practice Address - Phone:213-570-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73519225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist