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General NPI Number Information
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NPI Number | 1902910235
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Entity Type | Individual
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Provider Name | KWON CHAE YI CERTIFIED PROSTHETIS
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Gender | Male
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2550 BEVERLY BOULEVARD SUITE 201
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City | LOS ANGELES
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State | CA
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Zip | 90057-1035
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Country | US
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Telephone | 213-388-5847
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Fax | 213-388-5848
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Provider Business Mailing Address
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Address Line | 2550 BEVERLY BOULEVARD SUITE 201
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City | LOS ANGELES
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State | CA
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Zip | 90057-1035
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Country | US
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Telephone | 213-388-5847
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Fax | 213-388-5848
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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