# THEA CENTER FOR REGENERATIVE MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Thea CRM, Thea Center for Regenerative Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588256069
- **Authorized official:** DR. JOY KONG MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (310) 592-7504

## Contact information

- **Practice address:** 9568 TOPANGA CANYON BLVD, CHATSWORTH, CA 91311-4011
- **Practice address phone:** (818) 356-8232
- **Practice address fax:** (818) 483-6262
- **Mailing address:** 9568 TOPANGA CANYON BLVD, CHATSWORTH, CA 91311-4011
- **Mailing address phone:** (818) 356-8232

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | — | NULL | — |
| 163W00000X | Registered Nurse | — | — | — |
| 175F00000X | Naturopath | — | NULL | — |
| 175F00000X | Naturopath | — | — | — |
| 2083P0500X | Preventive Medicine/Occupational Environmental Medicine Physician | — | NULL | — |
| 2083P0500X | Preventive Medicine/Occupational Environmental Medicine Physician | — | — | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | NULL | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/06/2021
- **Last updated:** 02/06/2021