Provider Demographics
NPI:1538466644
Name:PRECISION ORTHOTICS & PROSTHETICS, INC
Entity Type:Organization
Organization Name:PRECISION ORTHOTICS & PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KWON
Authorized Official - Middle Name:
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:1213-388-5847
Mailing Address - Street 1:2550 BEVERLY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1036
Mailing Address - Country:US
Mailing Address - Phone:213-388-5847
Mailing Address - Fax:213-388-5848
Practice Address - Street 1:15586 7TH STREET
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3224
Practice Address - Country:US
Practice Address - Phone:760-241-7774
Practice Address - Fax:760-241-7775
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRECISION ORTHOTICS & PROSTHETICS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier