Active NPI
Kenneth Ta
- Pharmacist
- Glendale, CA
National Provider Identifier
1376346494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 92485
- Practice address
- 2300 Mendocino Ave
Santa Rosa, CA 95403-3115 - Phone
- (707) 569-3111
- NPI assigned
- Apr 1, 2025
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 92485 | CA | Primary |
Addresses
Primary practice location
2300 Mendocino Ave
Santa Rosa, CA 95403-3115
Mailing address
2300 Mendocino Ave
Santa Rosa, CA 95403-3115
Phone (707) 569-3111
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1743465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789344000000",
"number": "1376346494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 MENDOCINO AVE",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954033115",
"telephone_number": "707-569-3111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 MENDOCINO AVE",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954033115",
"telephone_number": "707-569-3111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TA",
"first_name": "KENNETH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-04-01",
"last_updated": "2026-09-14",
"certification_date": "2026-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "92485",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.