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General NPI Number Information
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NPI Number | 1962018044
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Entity Type | Organization
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Legal Business Name | EXCEL SPINE CENTER A CALIFORNIA MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 6719 ALVARADO RD STE 304
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City | SAN DIEGO
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State | CA
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Zip | 92120-5265
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Country | US
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Telephone | 619-344-6918
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Fax |
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Provider Business Mailing Address
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Address Line | 6719 ALVARADO RD STE 304
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City | SAN DIEGO
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State | CA
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Zip | 92120-5265
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Country | US
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Telephone | 619-344-6918
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHOLL WAN KIM
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Credential | MD, PHD
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Telephone | 619-344-6918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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