Healthcare Provider Details

I. General information

NPI: 1073325825
Provider Name (Legal Business Name): XPSYZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3294 SHERI DR
SIMI VALLEY CA
93063-1085
US

IV. Provider business mailing address

3294 SHERI DR
SIMI VALLEY CA
93063-1085
US

V. Phone/Fax

Practice location:
  • Phone: 310-346-0390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KINGMAN HO
Title or Position: PARTNER
Credential:
Phone: 206-948-2751