Longevita Clinic, A Professional Corporation - Medicare Primary Care in Chatsworth, CA

Longevita Clinic, A Professional Corporation is a medicare enrolled primary clinic (Internal Medicine) in Chatsworth, California. The current practice location for Longevita Clinic, A Professional Corporation is 21757 Devonshire St Ste 1, Chatsworth, California. For appointments, you can reach them via phone at (805) 630-7149. The mailing address for Longevita Clinic, A Professional Corporation is 21757 Devonshire St Ste 1, Chatsworth, California and phone number is (818) 678-9875.

Longevita Clinic, A Professional Corporation is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1730774076. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (805) 630-7149.

Contact Information

Longevita Clinic, A Professional Corporation
21757 Devonshire St Ste 1
Chatsworth
CA 91311-2975
(805) 630-7149
(888) 981-8739

Primary Care Clinic Profile

Full NameLongevita Clinic, A Professional Corporation
SpecialityInternal Medicine
Location21757 Devonshire St Ste 1, Chatsworth, California
Authorized Official Name and PositionRichard Park (SECRETARY)
Authorized Official Contact8053681293
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Longevita Clinic, A Professional Corporation
21757 Devonshire St Ste 1
Chatsworth
CA 91311-2975

Ph: (818) 678-9875
Longevita Clinic, A Professional Corporation
21757 Devonshire St Ste 1
Chatsworth
CA 91311-2975

Ph: (805) 630-7149

NPI Details:

NPI Number1730774076
Provider Enumeration Date03/09/2021
Last Update Date02/24/2023

Medicare PECOS Information:

Medicare PECOS PAC ID9133528359
Medicare Enrollment IDO20210520001175

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Medical Identifiers

Medical identifiers for Longevita Clinic, A Professional Corporation such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1730774076NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207Q00000XFamily Medicine (* (Not Available))Secondary
207R00000XInternal Medicine (* (Not Available))Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Longevita Clinic, A Professional Corporation acts as a billing entity for following providers:
Provider NameRichard Park
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1174718134
PECOS PAC ID: 5698964906
Enrollment ID: I20110118000516

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Provider NamePhilip Kim
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1356781132
PECOS PAC ID: 5496054330
Enrollment ID: I20200715002512

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