Provider Demographics
NPI:1255381745
Name:KEY OF JOY PHYSICAL THERAPY & KEY OF JOY MEDICAL CLINIC
Entity type:Organization
Organization Name:KEY OF JOY PHYSICAL THERAPY & KEY OF JOY MEDICAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SOO
Authorized Official - Middle Name:H
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:213-388-7822
Mailing Address - Street 1:3727 W 6TH ST STE 602
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-5111
Mailing Address - Country:US
Mailing Address - Phone:213-388-7822
Mailing Address - Fax:
Practice Address - Street 1:3727 W 6TH ST STE 602
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-5111
Practice Address - Country:US
Practice Address - Phone:213-388-7822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9737171100000X
CAPT23721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19863Medicare ID - Type UnspecifiedPROVIDER NUMBER