MEDICARE: KLEAN START, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	197483	OTHER	CA	DRUG MEDICAL

General Provider Information

NPI Number	:	1265708689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KLEAN START, INC

Provider Business Mailing Address
First Line	:	3545 W LUTHER LN
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90305-1886
Country	:	US
Telephone Number	:	310-337-1292
Fax Number	:

Provider Business Practice Location Address
First Line	:	2606 N CENTRAL AVE
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90222-1640
Country	:	US
Telephone Number	:	310-751-0821
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. RUDOLPH WASHINGTON
Credential	:	MPA
Telephone Number	:	310-751-0821

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	03/29/2012

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Directions to “KLEAN START, INC ” Practice Location

Language	Start Address	Practice Location

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