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

Revival Health Medical Group PA

Organization General Practice Physician · NPI 1730856659

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

In the registry since
2021
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4661 Wilshire Blvd Unit 105
Los Angeles, CA 90010-3931
Phone: (703) 326-2029
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Physician (primary) Taxonomy 208D00000X

Record details

NPI number1730856659
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Eugene Kim — President · (703) 326-2029
NPI enumeratedAugust 27, 2021
Last updated in NPPESAugust 27, 2021
Certification dateAugust 10, 2021
Mailing address1601 N Sepulveda Blvd # 103, Manhattan Beach, CA 90266-5111

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