Provider Demographics
NPI:1891095949
Name:DR. KURENE MAO INC.
Entity Type:Organization
Organization Name:DR. KURENE MAO INC.
Other - Org Name:DR. KURENE MAO INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KURENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-830-1766
Mailing Address - Street 1:441 E CARSON ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2767
Mailing Address - Country:US
Mailing Address - Phone:310-830-1766
Mailing Address - Fax:
Practice Address - Street 1:441 E CARSON ST
Practice Address - Street 2:SUITE L
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2767
Practice Address - Country:US
Practice Address - Phone:310-830-1766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35972106H00000X
CAPT19284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty