Organization
MARTIN LUTHER KING JR COMMUNITY MEDICAL FOUNDATION
Active
Other names
MARTIN LURHER KING JR. COMMUNITY MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY STOUT STOUT (COO)
(424) 529-6755
Entity
Organization
Contact information
Practice address
12021 WILMINGTON AVE., BLDG. 11 SUITE 1000, LOS ANGELES, CA 90059-3019
(424) 529-6755
(424) 338-8984
Mailing address
12021 WILMINGTON AVE BLDG 11, LOS ANGELES, CA 90059-3019
(424) 529-6755
(424) 338-8984
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
171R00000X
Interpreter
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207VM0101X
Maternal & Fetal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
09/14/2016
Last updated
02/05/2026
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