Active NPI
Kathleen Russell Port, L. AC.
- Acupuncturist
- Los Angeles, CA
National Provider Identifier
1316240336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC6282
- Practice address
- 2211 Corinth Ave
Suite 202
Los Angeles, CA 90064-1650 - Phone
- (310) 230-0280
- Fax
- (310) 496-2108
- NPI assigned
- Dec 14, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC6282 | CA | Primary |
Addresses
Primary practice location
2211 Corinth Ave
Suite 202
Los Angeles, CA 90064-1650
Mailing address
657 El Medio Ave
Pacific Palisades, CA 90272-4226
Phone (310) 230-0280
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC6282 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1292284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292284800000",
"number": "1316240336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "657 EL MEDIO AVE",
"city": "PACIFIC PALISADES",
"state": "CA",
"postal_code": "902724226",
"telephone_number": "310-230-0280",
"fax_number": "310-496-2108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2211 CORINTH AVE",
"address_2": "SUITE 202",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900641650",
"telephone_number": "310-230-0280",
"fax_number": "310-496-2108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORT",
"first_name": "KATHLEEN",
"middle_name": "RUSSELL",
"name_prefix": "Ms.",
"credential": "L. AC.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-12-14",
"last_updated": "2010-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "AC6282",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.