Active NPI
Keith Allen Telligman
- Day Training/Habilitation Specialist
- Valley Glen, CA
National Provider Identifier
1093059917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Day Training/Habilitation Specialist
- License
- 9176
- Practice address
- 5966 Costello Ave
Valley Glen, CA 91401-4338 - Phone
- (818) 667-4365
- NPI assigned
- Nov 15, 2012
- Last updated
- May 8, 2025
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 9176 | CA | |
| Day Training/Habilitation Specialist | 373H00000X | 9176 | CA | Primary |
Addresses
Primary practice location
5966 Costello Ave
Valley Glen, CA 91401-4338
Mailing address
5966 Costello Ave
Valley Glen, CA 91401-4338
Phone (818) 667-4365
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9176 | CA | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1352937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1746662400000",
"number": "1093059917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5966 COSTELLO AVE",
"city": "VALLEY GLEN",
"state": "CA",
"postal_code": "914014338",
"telephone_number": "818-667-4365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5966 COSTELLO AVE",
"city": "VALLEY GLEN",
"state": "CA",
"postal_code": "914014338",
"telephone_number": "818-667-4365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TELLIGMAN",
"first_name": "KEITH",
"middle_name": "ALLEN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-11-15",
"last_updated": "2025-05-08",
"certification_date": "2025-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "CA",
"license": "9176",
"primary": false
},
{
"code": "373H00000X",
"taxonomy_group": "",
"desc": "Day Training/Habilitation Specialist",
"state": "CA",
"license": "9176",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valley Glen, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.