Healthcare Provider Details

I. General information

NPI: 1851999882
Provider Name (Legal Business Name): INTEGRATIVE WELLNESS PARTNERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 08/01/2021
Certification Date: 08/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BERKSHIRE RD
SMITHFIELD NC
27577-4748
US

IV. Provider business mailing address

603 E COLLEGE ST
WARSAW NC
28398-2104
US

V. Phone/Fax

Practice location:
  • Phone: 919-912-2400
  • Fax: 919-912-1555
Mailing address:
  • Phone: 910-659-1088
  • Fax: 888-446-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SEUNG WON KIM
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 919-912-2400