Healthcare Provider Details

I. General information

NPI: 1366753766
Provider Name (Legal Business Name): OPTIMAL HEALTH INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 AMAR RD SUITE D-1
WALNUT CA
91789-4166
US

IV. Provider business mailing address

18800 AMAR RD SUITE D-1
WALNUT CA
91789-4166
US

V. Phone/Fax

Practice location:
  • Phone: 626-965-9078
  • Fax: 626-965-9076
Mailing address:
  • Phone: 626-965-9078
  • Fax: 626-965-9076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-27615
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. HENRY KAN
Title or Position: OWNER
Credential: DC, QME
Phone: 626-965-9058