Organization
FOMUKONG HEALTH FOUNDATION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NDIKA FOMUKONG FNP/PAC (CHIEF EXECUTIVE OFFICER)
(310) 701-6703
Entity
Organization
Contact information
Practice address
2355 WESTWOOD BLVD # 332, LOS ANGELES, CA 90064-2109
(310) 701-6703
Mailing address
2355 WESTWOOD BLVD # 332, LOS ANGELES, CA 90064-2109
(310) 701-6703
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
2768722
CA
Other
Enumeration date
02/23/2013
Last updated
02/23/2013
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