Kenneth Bertram Elconin, M.D.

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

License

AFE17621 Issued in CA

Practice address

8405 Beverly Blvd
Los Angeles, CA 90048-3401

Phone

(323) 653-8622

Fax

(323) 658-6773

NPI assigned

Jun 5, 2007

Last updated

Jul 18, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184716800000",
    "number": "1215139647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 HOMEWOOD RD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900491906",
            "telephone_number": "310-472-2983",
            "fax_number": "310-472-0832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8405 BEVERLY BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900483401",
            "telephone_number": "323-653-8622",
            "fax_number": "323-658-6773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELCONIN",
        "first_name": "KENNETH",
        "middle_name": "BERTRAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-05",
        "last_updated": "2007-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "CA",
            "license": "AFE17621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Magdi H Elbassir, M.D.,
• Mohamed Elata Hassan Elbathani, MD. MSC
• Nancy Elbaum, RN
• Shani Ronit Elbogen, P.T., D.P.T.
• Nada M Elbuluk, MD
• Eld Unlimited Opportunities, Inc
• Jennifer Patrice Elder-Wolff, FNP
• Alyssa Elder, PT
• Charlotte Ebony Elder, M.A.
• Elderly Behavioral Wellness Services Inc

• Urgent Care Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Urgent Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2007; 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.