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Organization
KIR MEDICAL GROUP
Active
Organization
KIR MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAY MOA MD (OWNER)
(310) 987-6543
Entity
Organization
Contact information
Practice address
123 177TH STREET, LOS ANGELES, CA 90004
(310) 987-6543
Mailing address
123 30TH STREET, LOS ANGELES, CA 90004
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A109876
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
654789098
—
CA
Enumeration date
10/03/2013
Last updated
10/03/2013
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