MEDICARE: OMEGA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist
3	225200000X	Physical Therapy Assistant
4	225700000X	Massage Therapist
5	224Z00000X	Occupational Therapy Assistant

General Provider Information

NPI Number	:	1114484391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMEGA, INC.

Provider Business Mailing Address
First Line	:	14774 BEACH BLVD
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-4250
Country	:	US
Telephone Number	:	714-670-0007
Fax Number	:	714-670-0006

Provider Business Practice Location Address
First Line	:	14774 BEACH BLVD
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-4250
Country	:	US
Telephone Number	:	714-670-0007
Fax Number	:	714-670-0006

Authorized Official
Title or Position	:	CEO
Name	:	KYUNG RAN TAE
Credential	:	OTR/L
Telephone Number	:	714-670-0007

Provider Enumeration Date	:	02/25/2019
Last Update Date	:	02/25/2019

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Directions to “OMEGA, INC. ” Practice Location

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