Individual provider Active NPI

Kelsey Breig

  • Family Nurse Practitioner
  • Gardena, CA
National Provider Identifier
1578076055
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95007304 Issued in CA
Practice address
742 W Gardena Blvd
Gardena, CA 90247-5024
Phone
(310) 327-1357
NPI assigned
Nov 7, 2017
Last updated
Dec 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95007304 CA Primary

Addresses

Primary practice location

742 W Gardena Blvd
Gardena, CA 90247-5024

Mailing address

PO Box 4571
Palos Verdes Peninsula, CA 90274-9608

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240223003253 CA Practitioner - Nurse Practitioner 2365709839 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Venice Family Clinic Current Accepting new patients
Venice Family Clinic Current Accepting new patients
Venice Family Clinic CurrentSince Jan 2, 2024 Accepting new patients
Venice Family Clinic CurrentSince Jan 2, 2024 Accepting new patients
Venice Family Clinic Current Accepting new patients

Locations

742 W Gardena Blvd
Gardena, CA 90247
Phone (310) 327-1357

4700 Inglewood Blvd
Ste 102
Los Angeles, CA 90230
Phone (310) 664-7901

2509 Pico Blvd
Santa Monica, CA 90405
Phone (310) 664-7901

604 Rose Ave
Venice, CA 90291
Phone (310) 392-8630

905 Venice Blvd
Venice, CA 90291
Phone (310) 392-8630

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: kbreig753242@direct.ochin.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1510012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1578076055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4571",
            "city": "PALOS VERDES PENINSULA",
            "state": "CA",
            "postal_code": "902749608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "742 W GARDENA BLVD",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902475024",
            "telephone_number": "310-327-1357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREIG",
        "first_name": "KELSEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-07",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95007304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardena, CA

Sources for this page

Verify at the official NPI Registry.