MEDICARE: KAPWA PHYSICAL THERAPY AND PERFORMANCE, PC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1669225116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAPWA PHYSICAL THERAPY AND PERFORMANCE, PC

Provider Business Mailing Address
First Line	:	8605 SANTA MONICA BLVD # 238791
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-4109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4302 MELROSE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-3511
Country	:	US
Telephone Number	:	702-580-7489
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF PHYSICAL THERAPY
Name	:	DR. JOHN PATRICK DUNGCA GAN
Credential	:	DPT
Telephone Number	:	702-580-7489

Provider Enumeration Date	:	04/05/2024
Last Update Date	:	04/05/2024

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