Individual
MR. KENZIE JAMAL MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
5954 EDGEMAR AVE, LOS ANGELES, CA 90043-3452
(323) 559-1541
Mailing address
5954 EDGEMAR AVE, LOS ANGELES, CA 90043-3452
(323) 559-1541
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
04/11/2013
Last updated
04/11/2013
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