Basic Information
| Provider Information | |||||||||
| NPI: | 1811532971 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VOONG | ||||||||
| FirstName: | KRISTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2457 ENDICOTT ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900323047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233182520 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6130 VINELAND AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916064914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187668161 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2019 | ||||||||
| LastUpdateDate: | 11/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.