MEDICARE: KD CARE FACILITY, 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1689380057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KD CARE FACILITY, INC.

Provider Business Mailing Address
First Line	:	3080 MADISON AVE
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-2824
Country	:	US
Telephone Number	:	714-679-2590
Fax Number	:

Provider Business Practice Location Address
First Line	:	3080 MADISON AVE
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-2824
Country	:	US
Telephone Number	:	714-679-2590
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KHANH K DO
Credential	:
Telephone Number	:	714-679-2590

Provider Enumeration Date	:	01/27/2023
Last Update Date	:	01/27/2023

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