Mek Kennedy, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

970000040 Issued in CA

Legal business name

MEK KENNEDY, LLC

Doing business as

Kennedy Care Center

Practice address

619 N Fairfax Ave
Los Angeles, CA 90036-1714

Phone

(132) 365-1004

Fax

(132) 365-1375

NPI assigned

Jun 27, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Fernan Pedraja

Title

Member

Phone

(181) 824-7620

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kennedy Care Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460332800000",
    "number": "1144226861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1506 S GLENDALE AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912053316",
            "telephone_number": "181-824-7620",
            "fax_number": "181-824-7712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 N FAIRFAX AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900361714",
            "telephone_number": "132-365-1004",
            "fax_number": "132-365-1375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEK KENNEDY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-27",
        "last_updated": "2016-04-11",
        "status": "A",
        "authorized_official_last_name": "PEDRAJA",
        "authorized_official_first_name": "FERNAN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "181-824-7620",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "970000040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA ID NUMBER",
            "identifier": "05D0556903",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05977G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kennedy Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Teresa Mejia, PHD
• Valeria Mejia
• Vanessa Guadalupe Mejia
• Wendy Mejia
• Kyle Francis Manuel Mejico
• Gautham Gosh Meka, M.D.
• Mekagreen Inc (mekagreen Pharmacy)
• Mariana Magdi Mekari
• Kenichi Mekaru
• Elite Mekel

• Skilled Nursing Facility in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.