Kenneth P Peterson, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

C50553 Issued in CA

Practice address

15910 Ventura Blvd
Suite 1502
Encino, CA 91436-2802

Phone

(818) 728-9877

NPI assigned

Apr 27, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Desert Vista Anesthesiology Medical Group, Inc.

  • Anesthesiology Physician
  • Victorville, CA
  • NPI 1275674517
  NPD (past) Authorized official
• Panmed Anesthesia Services Inc

  • Anesthesiology Physician
  • Chino, CA
  • NPI 1659691970
  NPD (past)

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396310400000",
    "number": "1144287707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15910 VENTURA BLVD",
            "address_2": "SUITE 1502",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362802",
            "telephone_number": "818-728-9877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15910 VENTURA BLVD",
            "address_2": "SUITE 1502",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362802",
            "telephone_number": "818-728-9877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KENNETH",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2014-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "C50553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "G50553",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Flicker Pescione, PH.D
• Peter C Nissler DDS a Dental Corp
• Peter R. Shrier, M.D.
• Glenn Allen Peters, PHD
• Timothy Allen Petersen, PSY.D.
• Stephanie Marie Pettigrew
• Peyman Gravori, D.O. Inc., a Professional Medical Corporation
• Cynthia Pezeshgian, NP
• Beata Pezeshki, DDS
• Nancy Pezeshki, PHARM. D.

• Anesthesiology Physician in Encino, CA
• Providers in Encino, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2014; 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.