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General NPI Number Information
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NPI Number | 1568985463
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Entity Type | Organization
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Legal Business Name | POWER HEALING MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 07/23/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1251 W REDONDO BEACH BLVD FL 3
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City | GARDENA
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State | CA
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Zip | 90247-3464
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Country | US
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Telephone | 310-965-0500
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Fax | 310-965-0055
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Provider Business Mailing Address
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Address Line | 1251 W REDONDO BEACH BLVD FL 3
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City | GARDENA
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State | CA
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Zip | 90247-3464
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Country | US
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Telephone | 310-965-0500
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Fax | 310-965-0055
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOONG GAP KIM
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Credential | MD
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Telephone | 310-965-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A39214
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CA18720
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License Number State | CA
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