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General NPI Number Information
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NPI Number | 1669607883
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Entity Type | Individual
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Provider Name | KENNETH JEREMY YCMAT D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 8535 SANTA MONICA BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-4100
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Country | US
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Telephone | 323-599-0312
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Fax |
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Provider Business Mailing Address
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Address Line | 8535 SANTA MONICA BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-4100
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Country | US
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Telephone | 323-599-0312
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC-31233
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License Number State | CA
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