Healthcare Provider Details

I. General information

NPI: 1396989182
Provider Name (Legal Business Name): KDJ ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1439 W CHAPMAN AVE SUITE 59
ORANGE CA
92868-2738
US

IV. Provider business mailing address

PO BOX 23009
SANTA ANA CA
92711-3009
US

V. Phone/Fax

Practice location:
  • Phone: 714-791-1735
  • Fax:
Mailing address:
  • Phone: 714-791-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KANDACE MORRIS
Title or Position: MANAGING PARTNER
Credential:
Phone: 714-791-1734