Provider Demographics
NPI:1962018044
Name:EXCEL SPINE CENTER A CALIFORNIA MEDICAL CORPORATION
Entity Type:Organization
Organization Name:EXCEL SPINE CENTER A CALIFORNIA MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHOLL
Authorized Official - Middle Name:WAN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:619-344-6918
Mailing Address - Street 1:6719 ALVARADO RD STE 304
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5265
Mailing Address - Country:US
Mailing Address - Phone:619-344-6918
Mailing Address - Fax:
Practice Address - Street 1:6719 ALVARADO RD STE 304
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5265
Practice Address - Country:US
Practice Address - Phone:619-344-6918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty