Individual
CO LUU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
1035 S VERMONT AVE, LOS ANGELES, CA 90006-2710
(213) 387-0102
Mailing address
4308 JERRY AVE, BALDWIN PARK, CA 91706-3024
(323) 580-8086
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
293323
CA
Other
Enumeration date
08/03/2017
Last updated
07/21/2022
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