Healthcare Provider Details

I. General information

NPI: 1053852772
Provider Name (Legal Business Name): CAREHOME DOCTORS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S OXFORD AVE APT 17
LOS ANGELES CA
90020-4228
US

IV. Provider business mailing address

501 S OXFORD AVE APT 17
LOS ANGELES CA
90020-4228
US

V. Phone/Fax

Practice location:
  • Phone: 213-505-7667
  • Fax:
Mailing address:
  • Phone: 213-505-7667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BRYAN KIM
Title or Position: CEO
Credential: M.D.
Phone: 303-900-2221