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General NPI Number Information
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NPI Number | 1609565811
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Entity Type | Individual
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Provider Name | MR. BENJAMIN JAMES KEDWARDS
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Gender | Male
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 4050 KATELLA AVE STE 107
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3466
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Country | US
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Telephone | 562-430-4451
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Fax |
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Provider Business Mailing Address
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Address Line | 4050 KATELLA AVE STE 107
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3466
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Country | US
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Telephone | 562-430-4451
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 38145
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License Number State | CA
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