MEDICARE: KIZ LLC

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1730953415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIZ LLC

Provider Business Mailing Address
First Line	:	4055 E OLYMPIC BLVD STE 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-3345
Country	:	US
Telephone Number	:	323-725-1144
Fax Number	:	323-725-1153

Provider Business Practice Location Address
First Line	:	4055 E OLYMPIC BLVD STE 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-3345
Country	:	US
Telephone Number	:	323-725-1144
Fax Number	:	323-725-1153

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM MARTINEZ
Credential	:	PA-C
Telephone Number	:	213-483-3600

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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Directions to “KIZ LLC ” Practice Location

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