Basic Information
Provider Information
NPI: 1770135345
EntityType: 2
ReplacementNPI:  
OrganizationName: KPC GLOBAL MEDICAL CENTER OF SOUTH LOS ANGELES LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: GLOBAL MEDICAL CENTER OF SOUTH LOS ANGELES
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9 KPC PKWY STE 301
Address2:  
City: CORONA
State: CA
PostalCode: 928797102
CountryCode: US
TelephoneNumber: 9519878100
FaxNumber:  
Practice Location
Address1: 3630 E IMPERIAL HWY
Address2:  
City: LYNWOOD
State: CA
PostalCode: 902622609
CountryCode: US
TelephoneNumber: 2134847111
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/12/2019
LastUpdateDate: 07/12/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: THOMAS
AuthorizedOfficialFirstName: WILLIAM
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: SECRETARY
AuthorizedOfficialTelephone: 9519878100
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X  Y HospitalsGeneral Acute Care Hospital 

No ID Information.


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