Active NPI
Kenn Rafanan
- Family Nurse Practitioner
- El Segundo, CA
National Provider Identifier
1003332909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 95006905
- Practice address
- 2101 Rosecrans Ave # 3230
El Segundo, CA 90245-4749 - Phone
- (323) 628-8671
- NPI assigned
- Aug 22, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 95006905 | CA | Primary |
Addresses
Primary practice location
2101 Rosecrans Ave # 3230
El Segundo, CA 90245-4749
Mailing address
1723 Bonanza Ave
Simi Valley, CA 93063-5803
Phone (818) 730-2452
Other practice location 1
1723 Bonanza Ave
Simi Valley, CA 93063
Phone (818) 730-2452
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95006905 | CA | MD | Family Nurse Practitioner |
Interoperability endpoints
- krafanan@landmarkhealth-direct.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571875200000",
"number": "1003332909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1723 BONANZA AVE",
"city": "SIMI VALLEY",
"state": "CA",
"postal_code": "930635803",
"telephone_number": "18187302452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 ROSECRANS AVE # 3230",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902454749",
"telephone_number": "323-628-8671"
}
],
"practiceLocations": [
{
"address_1": "1723 Bonanza Ave",
"address_purpose": "LOCATION",
"city": "Simi Valley",
"state": "CA",
"postal_code": "93063",
"country_code": "US",
"telephone_number": "818-730-2452",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RAFANAN",
"first_name": "KENN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-22",
"last_updated": "2019-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "95006905",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Segundo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.