Provider Demographics
NPI:1518399674
Name:KI WELLNESS & HEALING CENTER INC.
Entity Type:Organization
Organization Name:KI WELLNESS & HEALING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WINY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DE LOS SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-619-5281
Mailing Address - Street 1:1250 SW 27TH AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4749
Mailing Address - Country:US
Mailing Address - Phone:305-643-0896
Mailing Address - Fax:305-643-4011
Practice Address - Street 1:1250 SW 27TH AVE STE 305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4749
Practice Address - Country:US
Practice Address - Phone:305-643-0896
Practice Address - Fax:305-643-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9845261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center