Provider Demographics
NPI:1609378777
Name:KPW MEDICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:KPW MEDICAL ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEC
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-200-1113
Mailing Address - Street 1:3445 PACIFIC COAST HWY STE 310
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6660
Mailing Address - Country:US
Mailing Address - Phone:310-602-5005
Mailing Address - Fax:310-530-3912
Practice Address - Street 1:3445 PACIFIC COAST HWY STE 310
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6660
Practice Address - Country:US
Practice Address - Phone:310-602-5005
Practice Address - Fax:310-530-3912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKYLINE UROLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61375208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty