Kenneth C Nieberg MD Inc
Organization Active NPI Anatomic Pathology & Clinical Pathology Physician · Hollywood, CA
NPI 1144281163 · NPPES record last updated Jun 1, 2010
Key facts
- NPI
- 1144281163
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
- Legal business name
- KENNETH C NIEBERG MD INC
- Practice address
- 6245 De Longpre Ave
Hollywood, CA 90028-8253 - Phone
- (323) 462-2271
- NPI assigned
- Mar 29, 2006
- Organization subpart
- No
Authorized official
- Name
- Kenneth C Nieberg, MD
- Title
- President
- Phone
- (323) 462-2271
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cytopathology Physician |
207ZC0500X | |||
| Anatomic Pathology & Clinical Pathology Physician |
207ZP0102X | Yes |
Addresses
Primary practice location
6245 De Longpre Ave
Hollywood, CA 90028-8253
Mailing address
PO Box 10076
Van Nuys, CA 91410-0076
Phone (805) 578-8300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0023260 | Medicaid | CA |
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- Justin Kemp
- Monica M Kenyon
- Alan Sky Keo
- Zahid Khan
- Robert Kilgore
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All providers in Hollywood, CA · Anatomic Pathology & Clinical Pathology 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 Jun 1, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.