Healthcare Provider Details

I. General information

NPI: 1104591999
Provider Name (Legal Business Name): KTOWN MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 WILSHIRE BLVD STE 115
LOS ANGELES CA
90010-2502
US

IV. Provider business mailing address

3580 WILSHIRE BLVD STE 115
LOS ANGELES CA
90010-2502
US

V. Phone/Fax

Practice location:
  • Phone: 818-288-2757
  • Fax:
Mailing address:
  • Phone: 818-288-2757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN DO
Title or Position: DIRECTOR
Credential: MD
Phone: 818-288-2757