Doctor Name: | KENTON S. WAN |
NPI Number: | 1023413457 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.P.T |
License Number: | PT41828 |
Business Practice Address: | 3831 Hughes Ave Suite # 104 Culver City, CA - 902322751 |
Business Phone Number: | 3108379700 |
Business Fax Number: | 3108379701 |
Mailing Address: | 3831 Hughes Ave, Suite # 104 CULVER CITY |
State: | CA |
Postal Code: | 902322751 |
Phone Number: | 3108379700 |
Fax Number: | 3108379701 |
NPI Enumeration Date: | 10/28/2014 |
NPI Last Update Date: | 10/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT41828 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |