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General NPI Number Information
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NPI Number | 1124250642
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Entity Type | Organization
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Legal Business Name | ALL-N-1 MED CORP
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Dates
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Enumeration Date | 08/17/2009
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Last Update Date | 08/17/2009
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Provider Practice Location Address
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Address Line | 4032 WILSHIRE BLVD SUITE 303
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City | LOS ANGELES
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State | CA
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Zip | 90010-3405
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Country | US
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Telephone | 323-532-9308
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Fax |
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Provider Business Mailing Address
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Address Line | 5001 WILSHIRE BLVD SUITE 112-623
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City | LOS ANGELES
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State | CA
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Zip | 90036-6104
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Country | US
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Telephone | 323-532-9308
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Fax | 323-227-1998
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH GERARD KACZOR
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Credential | M.D.
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Telephone | 323-532-9308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | G60626
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License Number State | CA
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