Healthcare Provider Details

I. General information

NPI: 1891915567
Provider Name (Legal Business Name): ONEGENERATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17400 VICTORY BLVD
VAN NUYS CA
91406-5349
US

IV. Provider business mailing address

17400 VICTORY BLVD
VAN NUYS CA
91406-5349
US

V. Phone/Fax

Practice location:
  • Phone: 718-708-6625
  • Fax: 818-996-2960
Mailing address:
  • Phone: 718-708-6625
  • Fax: 818-996-2960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH KANG
Title or Position: CFO/COO
Credential:
Phone: 818-708-6373