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General NPI Number Information
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NPI Number | 1063948958
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Entity Type | Organization
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Legal Business Name | KIMIA WELLNESS
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 11540 SANTA MONICA BLVD SUITE 203
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City | LOS ANGELES
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State | CA
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Zip | 90025-7905
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Country | US
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Telephone | 310-882-8228
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Fax |
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Provider Business Mailing Address
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Address Line | 1937 GREENFIELD AVE
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City | LOS ANGELES
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State | CA
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Zip | 90025-5711
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Country | US
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Telephone | 310-882-8228
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Fax |
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Authorized Official
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Title or Position | OWNER L.AC.
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Name | ROY KIMIA
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Credential | MS ORIENTAL MED
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Telephone | 310-882-8228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 17546
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License Number State | CA
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