Healthcare Provider Details

I. General information

NPI: 1538667878
Provider Name (Legal Business Name): KAISER PERMANENTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 WESTPARK DR
MC LEAN VA
22102-3109
US

IV. Provider business mailing address

8008 WESTPARK DR
MC LEAN VA
22102-3109
US

V. Phone/Fax

Practice location:
  • Phone: 844-549-0597
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305211723
License Number StateVA

VIII. Authorized Official

Name: RICHARD YOO
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 330-204-7121