Healthcare Provider Details

I. General information

NPI: 1942137849
Provider Name (Legal Business Name): KYLE MASAMICHI WOO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 ARTESIA BLVD STE 107
REDONDO BEACH CA
90278-3412
US

IV. Provider business mailing address

1920 HANSCOM DR
SOUTH PASADENA CA
91030-4010
US

V. Phone/Fax

Practice location:
  • Phone: 424-275-9968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: