Provider Demographics
NPI:1033350608
Name:KINCAIDS NUTRITION CENTER
Entity Type:Organization
Organization Name:KINCAIDS NUTRITION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YONG
Authorized Official - Middle Name:SUNG
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-726-1947
Mailing Address - Street 1:711 NEWMARK MALL
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4752
Mailing Address - Country:US
Mailing Address - Phone:323-726-1947
Mailing Address - Fax:323-726-1948
Practice Address - Street 1:711 NEWMARK MALL
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4752
Practice Address - Country:US
Practice Address - Phone:323-726-1947
Practice Address - Fax:323-726-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12375261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center