Healthcare Provider Details

I. General information

NPI: 1902605447
Provider Name (Legal Business Name): HYENA PHYSICAL THERAPY LA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2025
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 S WESTMORELAND AVE 201
LOS ANGELES CA
90005
US

IV. Provider business mailing address

864 GRAND AVE #98
SAN DIEGO CA
92109
US

V. Phone/Fax

Practice location:
  • Phone: 818-934-0616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID KIM
Title or Position: PRESIDENT
Credential:
Phone: 818-934-0616