Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
PRIMARY CARE HEALTH CLINIC
Active
Organization
PRIMARY CARE HEALTH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NDIKA FOMUKONG NP (CEO)
(310) 701-6703
Entity
Organization
Contact information
Practice address
1601 W WASHINGTON BLVD, LOS ANGELES, CA 90007-1116
(310) 701-6703
Mailing address
1601 W WASHINGTON BLVD, LOS ANGELES, CA 90007-1116
(310) 701-6703
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34954
CA
207R00000X
Internal Medicine Physician
34954
CA
207V00000X
Obstetrics & Gynecology Physician
34954
CA
207VG0400X
Gynecology Physician
34954
CA
208D00000X
General Practice Physician
34954
CA
Other
Enumeration date
06/19/2013
Last updated
01/13/2016
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign upProduct
Developers