Healthcare Provider Details

I. General information

NPI: 1770390346
Provider Name (Legal Business Name): BREANNA KUIMI IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8605 SANTA MONICA BLVD PMB 30911
WEST HOLLYWOOD CA
90069
US

IV. Provider business mailing address

2860 S RIMPAU BLVD
LOS ANGELES CA
90016-3530
US

V. Phone/Fax

Practice location:
  • Phone: 213-343-5400
  • Fax:
Mailing address:
  • Phone: 213-343-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: