Organization
REVIVAL HEALTH MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EUGENE L. KIM MD (PRESIDENT)
(703) 326-2029
Entity
Organization
Contact information
Practice address
4661 WILSHIRE BLVD UNIT 105, LOS ANGELES, CA 90010-3931
(703) 326-2029
Mailing address
1601 N SEPULVEDA BLVD # 103, MANHATTAN BEACH, CA 90266-5111
(703) 326-2029
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
08/27/2021
Last updated
08/27/2021
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