Healthcare Provider Details

I. General information

NPI: 1558485508
Provider Name (Legal Business Name): PK HEALTHCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/21/2022
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 TORRANCE BLVD STE 101
TORRANCE CA
90501-0519
US

IV. Provider business mailing address

2275 TORRANCE BLVD STE 101
TORRANCE CA
90501-0519
US

V. Phone/Fax

Practice location:
  • Phone: 310-618-1988
  • Fax: 310-618-1996
Mailing address:
  • Phone: 310-618-1988
  • Fax: 310-618-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateCA

VIII. Authorized Official

Name: SANG KIM
Title or Position: CEO
Credential:
Phone: 310-618-1988