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General NPI Number Information
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NPI Number | 1902751886
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Entity Type | Organization
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Legal Business Name | FOOTFAIRY LLC
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Dates
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Enumeration Date | 03/04/2026
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 4708 VISTA DEL MONTE AVE
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2941
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Country | US
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Telephone | 315-206-4310
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Fax |
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Provider Business Mailing Address
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Address Line | 4708 VISTA DEL MONTE AVE
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2941
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Country | US
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Telephone | 315-206-4310
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | GI RYOUNG KWON
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Credential | DPM
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Telephone | 315-206-4310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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