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General NPI Number Information
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NPI Number | 1609378777
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Entity Type | Organization
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Legal Business Name | KPW MEDICAL ASSOCIATES, PC
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Dates
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Enumeration Date | 03/05/2018
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Last Update Date | 03/05/2018
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Provider Practice Location Address
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Address Line | 3445 PACIFIC COAST HWY STE 310
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City | TORRANCE
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State | CA
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Zip | 90505-6660
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Country | US
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Telephone | 310-602-5005
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Fax | 310-530-3912
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Provider Business Mailing Address
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Address Line | 3445 PACIFIC COAST HWY STE 310
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City | TORRANCE
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State | CA
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Zip | 90505-6660
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Country | US
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Telephone | 310-602-5005
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Fax | 310-530-3912
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Authorized Official
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Title or Position | PHYSICIAN PARTNER
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Name | ALEC S KOO
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Credential | MD
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Telephone | 310-200-1113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | G61375
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License Number State | CA
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