Healthcare Provider Details

I. General information

NPI: 1649673930
Provider Name (Legal Business Name): KOI CONCEPTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E ROUTE 66
GLENDORA CA
91740-6377
US

IV. Provider business mailing address

1191 HUNTINGTON DR #310
DUARTE CA
91010-2400
US

V. Phone/Fax

Practice location:
  • Phone: 626-258-7996
  • Fax:
Mailing address:
  • Phone: 626-215-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NATALIE TOMLINSON
Title or Position: PRESIDENT
Credential:
Phone: 626-215-4323