Healthcare Provider Details

I. General information

NPI: 1801198643
Provider Name (Legal Business Name): LIFE LINE WOUND CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22631 PACIFIC COAST HWY # 441
MALIBU CA
90265-5036
US

IV. Provider business mailing address

20301 VENTURA BLVD STE 115
WOODLAND HILLS CA
91364-0929
US

V. Phone/Fax

Practice location:
  • Phone: 310-459-9889
  • Fax: 206-202-4724
Mailing address:
  • Phone: 818-992-1801
  • Fax: 818-992-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVEN M KAYE
Title or Position: OWNER/CEO
Credential: M.D.
Phone: 818-992-1801