Provider Demographics
NPI:1215445044
Name:KAI WELLNESS
Entity type:Organization
Organization Name:KAI WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLIMTCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DACM, DIPLOM
Authorized Official - Phone:424-234-8024
Mailing Address - Street 1:2001 S BARRINGTON AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5379
Mailing Address - Country:US
Mailing Address - Phone:424-234-8024
Mailing Address - Fax:
Practice Address - Street 1:2001 S BARRINGTON AVE STE 309
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5379
Practice Address - Country:US
Practice Address - Phone:424-234-8024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-15
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17182171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1194279711Medicaid