Provider Demographics
NPI:1669225116
Name:KAPWA PHYSICAL THERAPY AND PERFORMANCE, PC
Entity type:Organization
Organization Name:KAPWA PHYSICAL THERAPY AND PERFORMANCE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN PATRICK
Authorized Official - Middle Name:DUNGCA
Authorized Official - Last Name:GAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:702-580-7489
Mailing Address - Street 1:8605 SANTA MONICA BLVD # 238791
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4302 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-3511
Practice Address - Country:US
Practice Address - Phone:702-580-7489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy