MEDICARE: KIKI QUEST MASSAGE THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	955	CA

General Provider Information

NPI Number	:	1073170197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIKI QUEST MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	1600 N BRONSON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 BEVERLY BLVD STE 402-6
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2230
Country	:	US
Telephone Number	:	213-392-7971
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2019
Last Update Date	:	07/08/2019

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