Healthcare Provider Details

I. General information

NPI: 1780123075
Provider Name (Legal Business Name): KINETIC ORTHOPAEDIC PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 06/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 SAWTELLE BLVD SUITE 190
LOS ANGELES CA
90025
US

IV. Provider business mailing address

1950 SAWTELLE BLVD SUITE 190
LOS ANGELES CA
90025-7014
US

V. Phone/Fax

Practice location:
  • Phone: 310-312-5678
  • Fax:
Mailing address:
  • Phone: 310-312-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT10216
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID H. PAKOZDI
Title or Position: OWNER/DIRECTOR
Credential: PT, OCS
Phone: 310-312-5678