| K C Medical Group Inc | |
|
191 S Buena Vista St Ste 375 Burbank CA 91505-4558 | |
| (818) 729-0014 | |
| (818) 729-0019 |
| Full Name | K C Medical Group Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 191 S Buena Vista St Ste 375, Burbank, California |
| Authorized Official Name and Position | Treasa Davis (PRESIDENT) |
| Authorized Official Contact | 8187290014 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| K C Medical Group Inc 10648 Woodbridge St Unit 302 North Hollywood CA 91602-3630 Ph: (818) 729-0014 | K C Medical Group Inc 191 S Buena Vista St Ste 375 Burbank CA 91505-4558 Ph: (818) 729-0014 |
| NPI Number | 1144733247 |
|---|---|
| Provider Enumeration Date | 11/10/2017 |
| Last Update Date | 11/10/2017 |
| Medicare PECOS PAC ID | 5092072975 |
|---|---|
| Medicare Enrollment ID | O20171130002810 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144733247 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Treasa Davis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336467620 PECOS PAC ID: 6709012461 Enrollment ID: I20131202001413 |
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