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REVIVAL HEALTH MEDICAL GROUP PA
NPI 1730856659
General Practice in Los Angeles, CA

Active since August 27, 2021
4661 WILSHIRE BLVD UNIT 105, LOS ANGELES, CA 90010(703) 326-2029 Get Directions Write a Review

NPPES record last updated: August 27, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Revival Health Medical Group Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REVIVAL HEALTH MEDICAL GROUP PA (NPI 1730856659) is a healthcare organization registered as a general practice in Los Angeles, California and active in the NPI registry since August 2021. The organization lists Eugene L. Kim, President, as its authorized official.

NPPES Registry Identity

NPI1730856659
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameREVIVAL HEALTH MEDICAL GROUP PA
Location Address4661 WILSHIRE BLVD UNIT 105Los Angeles, CA 90010-3931
Mailing Address1601 N Sepulveda Blvd # 103Manhattan Beach, CA 90266-5111 · (703) 326-2029
Phone(703) 326-2029
Organization SubpartNo
Authorized OfficialEugene L. KimPresident · (703) 326-2029
Enumeration DateAugust 27, 2021
NPPES CertifiedAugust 10, 2021
✔ NPI 1730856659 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

4661 WILSHIRE BLVD UNIT 105, Los Angeles, CA 90010
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

REVIVAL HEALTH MEDICAL GROUP
General Practice
4661 WILSHIRE BLVD UNIT 105
LOS ANGELES, CA 90010
Los Angeles County (703) 326-2029

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Revival Health Medical Group PA's NPI number?

The NPI number for Revival Health Medical Group PA is 1730856659. It was assigned to this organization in the NPPES registry on August 27, 2021.

Where is Revival Health Medical Group PA located?

Revival Health Medical Group PA is located at 4661 Wilshire Blvd Unit 105, Los Angeles, CA 90010. The listed phone number is (703) 326-2029.

What is Revival Health Medical Group PA's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

When was this NPI record last updated?

The NPPES record for Revival Health Medical Group PA was last updated on August 27, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.