# PRIMARY CARE HEALTH CLINIC

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

## Provider details

- **NPI number:** 1891134268
- **Authorized official:** MR. NDIKA FOMUKONG NP (CEO)
- **Authorized official phone:** (310) 701-6703

## Contact information

- **Practice address:** 1601 W WASHINGTON BLVD, LOS ANGELES, CA 90007-1116
- **Practice address phone:** (310) 701-6703
- **Mailing address:** 1601 W WASHINGTON BLVD, LOS ANGELES, CA 90007-1116
- **Mailing address phone:** (310) 701-6703

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 34954 | CA | Yes |
| 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