Graduated: 2025
NPI: 1982584991
Practice Locations (3)
5102 WILSHIRE BLVD, SUITE F
LOS ANGELES, CA 900364313
PO BOX, SUITE 95590
South Jordan, UT 840950590
PO BOX, SUITE 95590
SOUTH JORDAN, UT 84095
Source: CMS National Downloadable File, September 2026.