Healthcare Provider Details

I. General information

NPI: 1629231634
Provider Name (Legal Business Name): WENDY YANG KINCAID D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 RIVERSIDE DRIVE SUITE 5
NORTH HOLLYWOOD CA
91602
US

IV. Provider business mailing address

11650 RIVERSIDE DRIVE SUITE 5
NORTH HOLLYWOOD CA
91602
US

V. Phone/Fax

Practice location:
  • Phone: 818-980-1221
  • Fax: 818-980-3221
Mailing address:
  • Phone: 818-980-1221
  • Fax: 818-980-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 30898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: