Wilford Kyle Eiteman-Pang, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

300531 Issued in CA

Practice address

28210 Dorothy Dr
Agoura Hills, CA 91301-2297

Phone

(310) 699-7346

NPI assigned

Oct 13, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mesisca Physical Therapy IncGroup PAC ID 6406749548, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mesisca Physical Therapy Inc

  • Geriatric Physical Therapist
  • Laguna Niguel, CA
  • NPI 1821104472
  Medicare reassignment Care Compare group NPD
• JM Physical Therapy Inc

  • Physical Therapist
  • Laguna Niguel, CA
  • NPI 1558658336
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1881356129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15340 ALBRIGHT ST UNIT 301",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902722528",
            "telephone_number": "310-699-7346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28210 DOROTHY DR",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913012297",
            "telephone_number": "310-699-7346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EITEMAN-PANG",
        "first_name": "WILFORD",
        "middle_name": "KYLE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-13",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "300531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• East&West Medical Clinic
• Shady Ebbo
• Cynthia TL Edelstein
• Alexandra Edwards, PSY.D, MFT
• Laurie Eisenberg, PH.D.
• Elevation Behavioral Health
• Elevation Behavioral Health (Elevations)
• Tyler James Elias, LMFT
• Joeline Ellison, FNP
• Kenneth Donald Elman, MD

• Physical Therapist in Agoura Hills, CA
• Providers in Agoura Hills, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.