Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053788547 |
---|---|
Provider Name | Kevin C White |
First Address | Van Nuys, CA 91411-1608 |
Second Address | Van Nuys, CA 91411-1608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2015 |
Last Update Date | 31/08/2015 |