Active NPI
Robert Mark Penn, D.C.
- Chiropractor
- Huntington Park, CA
National Provider Identifier
1104268754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC18912
- Practice address
- 3480 Live Oak St.
Huntington Park, CA 90255 - Phone
- (323) 582-5159
- Fax
- (323) 582-1815
- NPI assigned
- Jul 24, 2013
- 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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC18912 | CA | Primary |
Addresses
Primary practice location
3480 Live Oak St.
Huntington Park, CA 90255
Mailing address
3480 Live Oak St.
Huntington Park, CA 90255
Phone (323) 582-5159
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 |
|---|---|---|---|
| DC18912 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374624000000",
"number": "1104268754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3480 LIVE OAK ST.",
"city": "HUNTINGTON PARK",
"state": "CA",
"postal_code": "90255",
"telephone_number": "323-582-5159",
"fax_number": "323-582-1815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3480 LIVE OAK ST.",
"city": "HUNTINGTON PARK",
"state": "CA",
"postal_code": "90255",
"telephone_number": "323-582-5159",
"fax_number": "323-582-1815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENN",
"first_name": "ROBERT",
"middle_name": "MARK",
"name_prefix": "Mr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-07-24",
"last_updated": "2013-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC18912",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntington Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.