Provider Demographics
NPI:1740831908
Name:KOA CAPITAL LTD, INC.
Entity type:Organization
Organization Name:KOA CAPITAL LTD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DYK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:310-968-2800
Mailing Address - Street 1:5061 HASKELL AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1548
Mailing Address - Country:US
Mailing Address - Phone:310-968-2800
Mailing Address - Fax:
Practice Address - Street 1:9665 WILSHIRE BLVD STE 450
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2446
Practice Address - Country:US
Practice Address - Phone:310-247-8414
Practice Address - Fax:310-247-9414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy