Healthcare Provider Details

I. General information

NPI: 1255987673
Provider Name (Legal Business Name): KALANI ADHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7872 WALKER ST SUITE 103
LA PALMA CA
90623
US

IV. Provider business mailing address

7872 WALKER ST SUITE 103
LA PALMA CA
90623
US

V. Phone/Fax

Practice location:
  • Phone: 714-309-4108
  • Fax:
Mailing address:
  • Phone: 714-309-4108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WINSTON C WONG
Title or Position: PRESIDENT
Credential: MD
Phone: 714-422-8445