Renee Johannah Penn, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

A103316 Issued in CA

Practice address

200 Medical Plaza
Suite 550
Los Angeles, CA 90024-0000

Phone

(310) 206-6688

NPI assigned

May 5, 2008

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• California Cancer Specialists Medical Group Inc

  • Anesthesiology Physician
  • Duarte, CA
  • NPI 1912006636

  Otolaryngology

  NPD (past)
• The Regents of the University of California

  • Surgery Physician
  • Los Angeles, CA
  • NPI 1619935251
  NPD (past)

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

{
    "created_epoch": "1209945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228348800000",
    "number": "1609042274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD",
            "address_2": "SUITE 200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455632",
            "telephone_number": "310-301-8708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MEDICAL PLAZA",
            "address_2": "SUITE 550",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900240000",
            "telephone_number": "310-206-6688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENN",
        "first_name": "RENEE",
        "middle_name": "JOHANNAH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-05",
        "last_updated": "2008-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A103316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0A1033160",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adam Penman, MD
• Alyssa Penn
• Casey Penn
• Elton John Penn
• Marquisha Daitierra Penn
• Pennacle Foundation, Inc.
• John Pennella
• Kristine Renee Penner Klein, MD
• Amy Beth Penner, LCSW
• Kelli Penner, M.S., LMFT 79102

• Otolaryngology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Otolaryngology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2008; 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.