Kenli T Black, COMMUNITY PEER

Primary specialty

Day Training/Habilitation SpecialistTaxonomy code 373H00000X

Practice address

1225 W 190TH St Ste 280
Gardena, CA 90248-4305

Phone

(877) 515-8113

NPI assigned

Apr 4, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Ehab Yacoub MD Inc.

  • Child & Adolescent Psychiatry Physician
  • Gardena, CA
  • NPI 1417373713
  NPD

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

{
    "created_epoch": "1712188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785628800000",
    "number": "1548012297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1729 1/2 W ADAMS BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900182702",
            "telephone_number": "916-730-6253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 W 190TH ST STE 280",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902484305",
            "telephone_number": "877-515-8113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KENLI",
        "middle_name": "T",
        "credential": "COMMUNITY PEER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-04-04",
        "last_updated": "2026-08-02",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "373H00000X",
            "taxonomy_group": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marques Binns
• Keandra Birden
• Roxette Bisarra
• Lorraine Carla B Biteranta
• Rosie Bittman
• Tiffany Alex Black
• Mone Blackburn, OTR/L
• Rochelle Blackett
• Mercedes Blackwell
• Erika Blancq Fernandez

• Day Training/Habilitation Specialist in Gardena, CA
• Providers in Gardena, CA by specialty
• Day Training/Habilitation Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.

Verify at the official NPI Registry.