# CHILDREN'S HOSPITAL LOS ANGELES MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124203872
- **Authorized official:** JAMES LIN (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (323) 361-1601

## Contact information

- **Practice address:** 4650 W SUNSET BLVD, LOS ANGELES, CA 90027-6062
- **Practice address phone:** (323) 361-2289
- **Mailing address:** 3250 WILSHIRE BLVD STE 1101, LOS ANGELES, CA 90010-1513

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0120X | Pediatric Surgery Physician | — | NULL | Yes |
| 2086S0120X | Pediatric Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/31/2007
- **Last updated:** 07/01/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR006667K | — | CA |