MEDICARE: KDJ HEALTHCARE INC

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	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	58812	OTHER	CA	CA BOARD OF PHARMACY

General Provider Information

NPI Number	:	1336260348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KDJ HEALTHCARE INC

Provider Business Mailing Address
First Line	:	2781-2783 W. OLYMPIC BLVD.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2632
Country	:	US
Telephone Number	:	213-816-0270
Fax Number	:	213-816-0271

Provider Business Practice Location Address
First Line	:	2781-2783 W. OLYMPIC BLVD.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2632
Country	:	US
Telephone Number	:	213-816-0270
Fax Number	:	213-816-0271

Authorized Official
Title or Position	:	CEO
Name	:	OLIVIA THAI
Credential	:
Telephone Number	:	213-816-0270

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	12/27/2022

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Directions to “KDJ HEALTHCARE INC ” Practice Location

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