Healthcare Provider Details

I. General information

NPI: 1730953415
Provider Name (Legal Business Name): KIZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 E OLYMPIC BLVD STE 205
LOS ANGELES CA
90023-3345
US

IV. Provider business mailing address

4055 E OLYMPIC BLVD STE 205
LOS ANGELES CA
90023-3345
US

V. Phone/Fax

Practice location:
  • Phone: 323-725-1144
  • Fax: 323-725-1153
Mailing address:
  • Phone: 323-725-1144
  • Fax: 323-725-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MARTINEZ
Title or Position: PRESIDENT
Credential: PA-C
Phone: 213-483-3600