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General NPI Number Information
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NPI Number | 1427485549
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Entity Type | Organization
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Legal Business Name | KIR MEDICAL GROUP
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 123 177TH STREET
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City | LOS ANGELES
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State | CA
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Zip | 90004
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Country | US
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Telephone | 310-987-6543
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Fax |
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Provider Business Mailing Address
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Address Line | 123 30TH STREET
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City | LOS ANGELES
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State | CA
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Zip | 90004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAY MOA
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Credential | MD
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Telephone | 310-987-6543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A109876
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License Number State | CA
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