# REVIVAL HEALTH MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194490342
- **Authorized official:** DR. EUGENE L. KIM MD (CEO)
- **Authorized official phone:** (703) 326-2029

## Contact information

- **Practice address:** 4661 WILSHIRE BLVD UNIT 105, LOS ANGELES, CA 90010-3931
- **Practice address phone:** (703) 326-2029
- **Mailing address:** 1601 N SEPULVEDA BLVD \# 103, MANHATTAN BEACH, CA 90266-5111
- **Mailing address phone:** (703) 326-2029

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/10/2021
- **Last updated:** 08/10/2021