Healthcare Provider Details

I. General information

NPI: 1538498878
Provider Name (Legal Business Name): KND DEVELPMENT 59 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N LARK ELLEN
WEST COVINA CA
91791-1069
US

IV. Provider business mailing address

680 S 4TH ST
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 626-339-5451
  • Fax: 502-596-4150
Mailing address:
  • Phone: 502-596-7358
  • Fax: 833-501-9731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA L FISHER
Title or Position: DVP REVENUE CYCLE
Credential:
Phone: 502-596-7358