Provider Demographics
NPI:1396321345
Name:JCK MEDICAL CORP
Entity type:Organization
Organization Name:JCK MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE- PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-301-1118
Mailing Address - Street 1:11500 W OLYMPIC BLVD STE 480
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1678
Mailing Address - Country:US
Mailing Address - Phone:310-477-4727
Mailing Address - Fax:
Practice Address - Street 1:11500 W OLYMPIC BLVD STE 480
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1678
Practice Address - Country:US
Practice Address - Phone:310-477-4727
Practice Address - Fax:310-477-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty