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General NPI Number Information
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NPI Number | 1891639464
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Entity Type | Organization
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Legal Business Name | KIWIMEDSPA MEDICAL WEIGHT LOSS & AESTHETICS LLC
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Dates
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Enumeration Date | 04/15/2026
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Last Update Date | 04/15/2026
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Provider Practice Location Address
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Address Line | 2103 BRASELTON HWY SUITE 120
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City | DACULA
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State | GA
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Zip | 30019
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Country | US
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Telephone | 678-936-6167
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Fax |
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Provider Business Mailing Address
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Address Line | 2103 BRASELTON HWY SUITE 120
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City | DACULA
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State | GA
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Zip | 30019
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Country | US
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Telephone | 678-936-6167
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | MARIA ANGEL
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Credential | MD
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Telephone | 678-936-6167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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