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Individual

MR. KWON CHAE YI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CERTIFIED PROSTHETIS

Contact information

Practice address
2550 BEVERLY BOULEVARD, SUITE 201, LOS ANGELES, CA 90057-1035
(213) 388-5847
(213) 388-5848
Mailing address
2550 BEVERLY BOULEVARD, SUITE 201, LOS ANGELES, CA 90057-1035
(213) 388-5847
(213) 388-5848

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
XB0023570
CA
01
ZZZ655562
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
08/17/2006
Last updated
07/08/2007
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