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1730856659
REVIVAL HEALTH MEDICAL GROUP PA
LOS ANGELES, CA
NPI
1730856659
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Entity Type
Organization
Authorized Contact
EUGENE L. KIM
President
703-326-2029
Organization Subpart ?
No
Primary Taxonomy
208D00000X General Practice
Enumeration Date
2021-08-27
Last Update Date
2021-08-27
Business Address
REVIVAL HEALTH MEDICAL GROUP PA
4661 WILSHIRE BLVD UNIT 105
LOS ANGELES, CA 90010-3931
Phone number: 703-326-2029
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Mailing Address
REVIVAL HEALTH MEDICAL GROUP PA
1601 N SEPULVEDA BLVD # 103
MANHATTAN BEACH, CA 90266-5111
Phone number: 703-326-2029
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