Healthcare Provider Details

I. General information

NPI: 1902002595
Provider Name (Legal Business Name): KAISER PERMANENTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 N EDGEMONT ST FL 4
LOS ANGELES CA
90027-5260
US

IV. Provider business mailing address

1917 RODNEY DR APT 318
LOS ANGELES CA
90027-3180
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-1340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number29602
License Number StateCA

VIII. Authorized Official

Name: MR. DAVID KURIHARA
Title or Position: PHYSICAL THERAPIST
Credential: P.T.
Phone: 323-662-5522