Healthcare Provider Details

I. General information

NPI: 1134034143
Provider Name (Legal Business Name): KITCHEN BONGOU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 W OLYMPIC BLVD
LOS ANGELES CA
90064-1550
US

IV. Provider business mailing address

147 S POINSETTIA PL
LOS ANGELES CA
90036-2803
US

V. Phone/Fax

Practice location:
  • Phone: 323-613-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: JAMES JOSEPH
Title or Position: OWNER
Credential:
Phone: 323-613-0300