Provider Demographics
NPI:1861032708
Name:K WELLNESS MEDICAL CENTER CORPORATION
Entity Type:Organization
Organization Name:K WELLNESS MEDICAL CENTER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-430-6312
Mailing Address - Street 1:701 E 28TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2769
Mailing Address - Country:US
Mailing Address - Phone:562-269-0300
Mailing Address - Fax:
Practice Address - Street 1:701 E 28TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2769
Practice Address - Country:US
Practice Address - Phone:562-269-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site