Provider Demographics
NPI:1932714326
Name:KINNECTED
Entity Type:Organization
Organization Name:KINNECTED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:T
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:310-902-0208
Mailing Address - Street 1:33 DRIFTWOOD ST APT 3
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5753
Mailing Address - Country:US
Mailing Address - Phone:310-902-0208
Mailing Address - Fax:
Practice Address - Street 1:33 DRIFTWOOD ST APT 3
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5753
Practice Address - Country:US
Practice Address - Phone:310-902-0208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty