Kenneth E Lynch, MD
Individual provider Active NPI Diagnostic Radiology Physician · Surfside, CA
NPI 1023093069 · NPPES record last updated Mar 13, 2015
Key facts
- NPI
- 1023093069
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- G17130 (CA)
- Practice address
- A59 Surfside Avenue
Surfside, CA 90743-0187 - Phone
- (714) 889-9659
- Fax
- (562) 217-1315
- NPI assigned
- Dec 13, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 13
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (6 enrollments) in CA, TX, NC, NV, FL, TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041206001167 | CA | Practitioner - Diagnostic Radiology | 3678477502 | Reassigns benefits to 1 organization |
| I20181217000350 | TX | Practitioner - Diagnostic Radiology | 3678477502 | |
| I20190509000056 | NC | Practitioner - Diagnostic Radiology | 3678477502 | Reassigns benefits to 1 organization |
| I20190515003322 | NV | Practitioner - Diagnostic Radiology | 3678477502 | |
| I20210622003637 | FL | Practitioner - Diagnostic Radiology | 3678477502 | |
| I20220602000101 | TN | Practitioner - Diagnostic Radiology | 3678477502 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G17130 | CA | MD | Vascular & Interventional Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| KND Development 59 , LLC | Current |
Accepting new patients | |
| American Health W LLC | Current |
Accepting new patients | |
| Golden State Imaging Associates Inc | Diagnostic Radiology | Current |
Accepting new patients |
| Mobile X-Ray of Austin Inc | Current |
Accepting new patients | |
| Rapid Radiology, Inc. | Diagnostic Radiology | Current |
Accepting new patients |
| American Health W LLC | Current |
Accepting new patients | |
| Memrad Medical Group Inc | Past | Accepting new patients | |
| Patriot Mobile Imaging, LLC | Past |
Accepting new patients | |
| Pih Health Whittier Hospital | Past | Accepting new patients | |
| Quantum Medical Radiology PC | Diagnostic Radiology | Past | Accepting new patients |
| Long Beach Memorial Medical | Past | Accepting new patients | |
| Universal Radiology Consultants PC | Diagnostic Radiology | Past |
Accepting new patients |
| Lambert Radiology Medical Group, Inc | Diagnostic Radiology | Past | Accepting new patients |
Locations (25 of 37)
17100 Euclid St
Fountain Vly, CA 92708
Phone (714) 966-7200
11190 Warner Ave
Ste 110
Fountain Vly, CA 92708
Phone (714) 431-0303
17100 Euclid St
Ste 4004
Fountain Vly, CA 92708
Phone (714) 966-7200
47111 Monroe St
#1112
Indio, CA 92201
47111 Monroe St
Indio, CA 92201
Phone (760) 347-6191
550 N Monterey Ave
Ontario, CA 91764
Phone (909) 629-2290
1150 N Indian Canyon Dr
Palm Springs, CA 92262
Phone (760) 323-6251
10841 White Oak Ave
Rch Cucamonga, CA 91730
Phone (626) 914-1514
555 Washington St
San Diego, CA 92103
Phone (619) 260-8300
1516 E Las Olas Blvd
Ft Lauderdale, FL 33301
Phone (954) 356-5142
765 W Nasa Blvd
Melbourne, FL 32901
Phone (321) 409-4044
3030 6th St S
St Petersburg, FL 33705
Phone (727) 894-8719
2401 S Side Blvd
Greensboro, NC 27406
Phone (336) 271-2800
2930 Siena Heights Dr
Henderson, NV 89052
Phone (702) 726-2000
315 Oak St
Livingston, TN 38570
Phone (931) 403-1197
2601 W Randol Mill Rd
Ste 101
Arlington, TX 76012
Phone (469) 893-0123
1000 N Cooper St
Arlington, TX 76011
Phone (817) 548-3400
6548 Comanche Trl
Ste 501
Austin, TX 78732
4929 Burney Dr
Ste 120
Corpus Christi, TX 78411
Phone (512) 673-7552
9525 Greenville Ave
Dallas, TX 75243
Phone (214) 335-2600
3500 Gaston Ave
Dallas, TX 75246
8050 Meadow Rd
Dallas, TX 75231
Phone (214) 396-5260
2990 Legacy Dr
Frisco, TX 75034
Phone (469) 888-5100
815 8th Ave
Ft Worth, TX 76104
Phone (817) 332-4812
7800 Oakmont Blvd
Ft Worth, TX 76132
Phone (817) 279-0225
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | G17130 | CA | Yes |
| Vascular & Interventional Radiology Physician | 2085R0204X | G17130 | CA |
Addresses
Primary practice location
A59 Surfside Avenue
Surfside, CA 90743-0187
Mailing address
PO Box 187
Surfside, CA 90743-0187
Phone (714) 889-9659
Other providers in Surfside, CA
All providers in Surfside, CA · Diagnostic Radiology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.