MEDICARE: KAI HEALTH & WELLNESS, 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	207QS0010X	Sports Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1881117273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAI HEALTH & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	36010 N 33RD LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-2298
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16620 N 40TH ST
Second Line	:	BUILDING I, SUITE 2
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3348
Country	:	US
Telephone Number	:	480-315-8322
Fax Number	:

Authorized Official
Title or Position	:	MEMBER/MANAGER
Name	:	ERIC POOLE
Credential	:
Telephone Number	:	602-493-0004

Provider Enumeration Date	:	07/18/2017
Last Update Date	:	07/24/2017

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