Healthcare Provider Details

I. General information

NPI: 1881349678
Provider Name (Legal Business Name): SOUTHLAND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10541 CALLE LEE STE 117
LOS ALAMITOS CA
90720-6781
US

IV. Provider business mailing address

10541 CALLE LEE STE 117
LOS ALAMITOS CA
90720-6781
US

V. Phone/Fax

Practice location:
  • Phone: 714-794-2777
  • Fax: 714-276-2353
Mailing address:
  • Phone: 714-794-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL KIM
Title or Position: PHYSICIAN
Credential: MD
Phone: 858-431-6143