=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285973867
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL FAMILY WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2013
-----------------------------------------------------
Last Update Date | 02/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15747 WOODRUFF AVE
-----------------------------------------------------
City | BELLFLOWER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90706-4017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-867-1570
-----------------------------------------------------
Fax | 562-867-1582
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15747 WOODRUFF AVE
-----------------------------------------------------
City | BELLFLOWER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90706-4017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-867-1570
-----------------------------------------------------
Fax | 562-867-1582
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PATRICIA A KAI
-----------------------------------------------------
Credential | MSN, FNP-BC
-----------------------------------------------------
Telephone | 562-867-1570
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | NP 20589
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------