Healthcare Provider Details

I. General information

NPI: 1811969652
Provider Name (Legal Business Name): KY EDWARD KUGLER EDD, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY DR
ORANGE CA
92866-1005
US

IV. Provider business mailing address

2256 WOODHOLLOW LN
CHINO HILLS CA
91709-1023
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-6642
  • Fax: 714-744-7035
Mailing address:
  • Phone: 714-997-6642
  • Fax: 714-744-7035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: