Provider Demographics
NPI:1659743433
Name:WEST COAST WELLNESS & PREVENTIVE CARE INC
Entity Type:Organization
Organization Name:WEST COAST WELLNESS & PREVENTIVE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-893-1222
Mailing Address - Street 1:7895 WESTMINSTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4043
Mailing Address - Country:US
Mailing Address - Phone:714-893-1222
Mailing Address - Fax:714-893-1244
Practice Address - Street 1:7895 WESTMINSTER BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4043
Practice Address - Country:US
Practice Address - Phone:714-893-1222
Practice Address - Fax:714-893-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42932207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty