Healthcare Provider Details

I. General information

NPI: 1972362861
Provider Name (Legal Business Name): ONE KINETIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 SEABRIGHT AVE STE E
SANTA CRUZ CA
95062-2120
US

IV. Provider business mailing address

1729 SEABRIGHT AVE STE E
SANTA CRUZ CA
95062-2120
US

V. Phone/Fax

Practice location:
  • Phone: 831-227-5083
  • Fax: 831-222-3053
Mailing address:
  • Phone: 831-227-5083
  • Fax: 831-222-3053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VUONG DUC DOAN
Title or Position: OWNER
Credential: LAC
Phone: 831-227-5083