Active NPI
Kenneth Li
- Optometrist
- Manhattan Beach, CA
National Provider Identifier
1174292551
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 34945
- Practice address
- 3200 N Sepulveda Blvd Ste E4
Manhattan Beach, CA 90266-2469 - Phone
- (310) 546-5568
- NPI assigned
- Sep 9, 2021
- Last updated
- Sep 9, 2021
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 34945 | CA | Primary |
Addresses
Primary practice location
3200 N Sepulveda Blvd Ste E4
Manhattan Beach, CA 90266-2469
Mailing address
1849 S Bentley Ave Apt 104
Los Angeles, CA 90025-4326
Phone (916) 753-8192
Other practice location 1
201 E Magnolia Blvd Ste 261
Burbank, CA 91502-1162
Phone (818) 841-2393
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34945 | CA | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maloney-Shamie Vision Institute | Past | Accepting new patients |
Interoperability endpoints
- kliod@maloneyshamie.direct.eyemdemr.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Ophthalmology Physician
- Los Angeles, CA
- NPI 1922501154
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631145600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631145600000",
"number": "1174292551",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1849 S BENTLEY AVE APT 104",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900254326",
"telephone_number": "916-753-8192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 N SEPULVEDA BLVD STE E4",
"city": "MANHATTAN BEACH",
"state": "CA",
"postal_code": "902662469",
"telephone_number": "310-546-5568"
}
],
"practiceLocations": [
{
"address_1": "201 E Magnolia Blvd Ste 261",
"address_purpose": "LOCATION",
"city": "Burbank",
"state": "CA",
"postal_code": "915021162",
"country_code": "US",
"telephone_number": "818-841-2393",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LI",
"first_name": "KENNETH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-09",
"last_updated": "2021-09-09",
"certification_date": "2021-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "34945",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manhattan Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.