Healthcare Provider Details

I. General information

NPI: 1861032708
Provider Name (Legal Business Name): K WELLNESS MEDICAL CENTER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST STE 100
LONG BEACH CA
90806-2769
US

IV. Provider business mailing address

701 E 28TH ST STE 100
LONG BEACH CA
90806-2769
US

V. Phone/Fax

Practice location:
  • Phone: 562-269-0300
  • Fax:
Mailing address:
  • Phone: 562-269-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY FEINBERG
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-430-6312