Lina Jacklyn Kennedy, M.D.

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

A141381 Issued in CA

Practice address

2121 E Coast Hwy Ste 280
Corona del Mar, CA 92625-1940

Phone

(949) 688-1288

NPI assigned

Apr 18, 2012

Sex

Female

Sole proprietor

No

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Howard University College of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00381

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.

• Grace Dermatology

  • Medical Specialty Clinic/Center
  • Los Alamitos, CA
  • NPI 1467231811
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1334707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695427200000",
    "number": "1467719260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 E COAST HWY STE 280",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926251940",
            "telephone_number": "949-688-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 E COAST HWY STE 280",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926251940",
            "telephone_number": "949-688-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "LINA",
        "middle_name": "JACKLYN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-18",
        "last_updated": "2023-09-23",
        "certification_date": "2023-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "A141381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lola Jontiff, RAD T
• Mark Tibor Kantor, RN
• Kaveh Karandish, MD
• Michele Kayiran, DPT
• Rachel Kelts
• Robert W Kessler, M. D.
• Kevin J Taylor DDS Inc
• Kha D Le Dental Corp.
• Khjavid and Mnadi Dental Corp
• Andy Chau Khuong, PHARMD

• Procedural Dermatology Physician in Corona del Mar, CA
• Providers in Corona del Mar, CA by specialty
• Procedural Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.