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General NPI Number Information
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NPI Number | 1841886488
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Entity Type | Organization
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Legal Business Name | KETAMINE INFUSION ASSOCIATES, INC.
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Dates
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Enumeration Date | 12/17/2020
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 2975 TREAT BOULEVARD SUITE NUMBER B-1
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City | CONCORD
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State | CA
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Zip | 94518
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Country | US
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Telephone | 925-357-9033
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Fax | 925-357-9036
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Provider Business Mailing Address
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Address Line | 2975 TREAT BOULEVARD SUITE NUMBER B-1
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City | CONCORD
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State | CA
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Zip | 94518
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Country | US
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Telephone | 925-357-9033
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Fax | 925-357-9036
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAN KIM
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Credential | M.D.
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Telephone | 925-357-9033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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