Healthcare Provider Details

I. General information

NPI: 1902956345
Provider Name (Legal Business Name): DAVID J KUOCH L.AC., MTOM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5553 W PICO BLVD
LOS ANGELES CA
90019-3919
US

IV. Provider business mailing address

5553 W PICO BLVD
LOS ANGELES CA
90019-3919
US

V. Phone/Fax

Practice location:
  • Phone: 323-930-9355
  • Fax: 323-930-9375
Mailing address:
  • Phone: 323-930-9355
  • Fax: 323-930-9375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 11466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: