Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Revival Health Medical Group

Organization General Practice Physician · NPI 1194490342

Revival Health Medical Group is a General Practice Physician in Los Angeles, California. Registered with an NPI since 2021.

In the registry since
2021

Practice location Address checks out

4661 Wilshire Blvd Unit 105
Los Angeles, CA 90010-3931
Phone: (703) 326-2029
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Physician (primary) Taxonomy 208D00000X

Record details

NPI number1194490342
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Eugene Kim — Ceo · (703) 326-2029
NPI enumeratedAugust 10, 2021
Last updated in NPPESAugust 10, 2021
Certification dateAugust 10, 2021
Mailing address1601 N Sepulveda Blvd # 103, Manhattan Beach, CA 90266-5111

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