Active NPI
Charles D Kenyon, MD
- Rheumatology Physician
- Anaheim, CA
National Provider Identifier
1043417447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- G23234
- Practice address
- 411 N Lakeview Ave
Anaheim, CA 92807-3028 - Phone
- (714) 279-5449
- NPI assigned
- Jun 29, 2007
- 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 |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | G23234 | CA | Primary |
Addresses
Primary practice location
411 N Lakeview Ave
Anaheim, CA 92807-3028
Mailing address
17081 Westport Dr
Huntington Beach, CA 92649-4219
Phone (714) 846-4913
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G23234 | CA | MD | Rheumatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043417447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17081 WESTPORT DR",
"city": "HUNTINGTON BEACH",
"state": "CA",
"postal_code": "926494219",
"telephone_number": "714-846-4913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 N LAKEVIEW AVE",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928073028",
"telephone_number": "714-279-5449"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENYON",
"first_name": "CHARLES",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "CA",
"license": "G23234",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.