Healthcare Provider Details

I. General information

NPI: 1396600581
Provider Name (Legal Business Name): MI WOL KALDENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17150 S PARK LN APT 115
GARDENA CA
90247-5773
US

IV. Provider business mailing address

1337 OAKHEATH DR
HARBOR CITY CA
90710-1224
US

V. Phone/Fax

Practice location:
  • Phone: 213-820-1914
  • Fax:
Mailing address:
  • Phone: 213-820-1914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number003434313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: