Healthcare Provider Details

I. General information

NPI: 1891095949
Provider Name (Legal Business Name): DR. KURENE MAO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 E CARSON ST SUITE L
CARSON CA
90745-2767
US

IV. Provider business mailing address

441 E CARSON ST SUITE L
CARSON CA
90745-2767
US

V. Phone/Fax

Practice location:
  • Phone: 310-830-1766
  • Fax:
Mailing address:
  • Phone: 310-830-1766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC35972
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19284
License Number StateCA

VIII. Authorized Official

Name: DR. KURENE MAO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 310-830-1766