Search › California › 171100000X
In Ki Park, LAC
NPI 1972744845 · on the registry since 2009
Practice
- Address
- 269 S La Fayette Park Pl Apt 449
Los Angeles, CA 90057 - Phone
- (213) 604-0081
- Fax
- (714) 522-8775
- Clinicians at this address
- 2
Registry record
- Primary taxonomy
- 171100000X
171100000X
- Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2009-03-23
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California