Healthcare Provider Details

I. General information

NPI: 1538466644
Provider Name (Legal Business Name): PRECISION ORTHOTICS & PROSTHETICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15586 7TH STREET
VICTORVILLE CA
92395-3224
US

IV. Provider business mailing address

2550 BEVERLY BLVD SUITE 201
LOS ANGELES CA
90057-1036
US

V. Phone/Fax

Practice location:
  • Phone: 760-241-7774
  • Fax: 760-241-7775
Mailing address:
  • Phone: 213-388-5847
  • Fax: 213-388-5848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. KWON YI
Title or Position: CEO
Credential: CP
Phone: 12133885847