Individual provider Active NPI

Kenneth Lewis, M.D.

  • Anesthesiology Physician
  • Los Angeles, CA
National Provider Identifier
1629154745
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
A48449 Issued in CA
Practice address
12021 S. Wilmington Ave
Los Angeles, CA 90059
Phone
(562) 427-5363
Fax
(562) 427-8802
NPI assigned
Oct 31, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A48449 CA Primary

Addresses

Primary practice location

12021 S. Wilmington Ave
Los Angeles, CA 90059

Mailing address

12021 S. Wilmington Ave
Los Angeles, CA 90059
Phone (562) 427-5363

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071227000366 CA Practitioner - AnesthesiologyPractitioner - Interventional Pain Management 5496835795 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Interventional Pain Management
Education
Howard University College of Medicine, 1987
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1670 E 120TH St
Los Angeles, CA 90059-3026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A48449CAMDAnesthesiology Physician
48449CAMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles CurrentSince Jan 7, 2012 Accepting new patients
County of Los Angeles CurrentSince Jan 7, 2012 Accepting new patients
Rancho Faculty Medical Associates, Inc. Past Accepting new patients

Locations

1000 S Fremont Ave
Bldg A11
Alhambra, CA 91803
Phone (626) 457-4240

7601 Imperial Hwy
Downey, CA 90242
Phone (310) 940-8111

1670 E 120th St
Los Angeles, CA 90059
Phone (424) 338-1000

12021 Wilmington Ave
Los Angeles, CA 90059
Phone (310) 668-4515

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629154745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12021 S. WILMINGTON AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90059",
            "telephone_number": "562-427-5363",
            "fax_number": "562-427-8802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12021 S. WILMINGTON AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90059",
            "telephone_number": "562-427-5363",
            "fax_number": "562-427-8802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A48449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.