Provider Demographics
NPI:1063096022
Name:KGK PERSONA INC
Entity type:Organization
Organization Name:KGK PERSONA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARAPET
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAPETYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-522-1499
Mailing Address - Street 1:9690 TELSTAR AVE STE 221
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-3000
Mailing Address - Country:US
Mailing Address - Phone:626-522-1499
Mailing Address - Fax:626-522-1491
Practice Address - Street 1:9690 TELSTAR AVE STE 221
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3000
Practice Address - Country:US
Practice Address - Phone:626-522-1499
Practice Address - Fax:626-522-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health