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General NPI Number Information
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NPI Number | 1881463545
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Entity Type | Organization
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Legal Business Name | KIBUN HEALTH NC PLLC
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Dates
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Enumeration Date | 12/21/2023
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 4108 PARK RD STE 321
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City | CHARLOTTE
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State | NC
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Zip | 28209-2259
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Country | US
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Telephone | 205-583-6661
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Fax | 617-362-2499
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Provider Business Mailing Address
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Address Line | PO BOX 18957
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City | CHARLOTTE
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State | NC
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Zip | 28218-0957
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIR.
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Name | PHILLIP SMITH
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Credential |
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Telephone | 205-583-6661
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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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