Robert J. McKenna Jr. MD, a Medical Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

License

G39081 Issued in CA

Legal business name

ROBERT J. MCKENNA JR. MD, A MEDICAL CORPORATION

Practice address

8635 W Third Street
No 975W
Los Angeles, CA 90048-6101

Phone

(310) 652-0530

Fax

(310) 652-9936

NPI assigned

Jan 22, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Robert Joseph McKenna Jr., MDNPI 1942210117

Title

Physician

Phone

(310) 652-0530

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Joseph McKenna Jr., M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Santa Monica, CA
  • NPI 1942210117
  NPD (past) Authorized official

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192060800000",
    "number": "1639222565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8635 W THIRD STREET",
            "address_2": "NO 975W",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900486101",
            "telephone_number": "310-652-0530",
            "fax_number": "310-652-9936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8635 W THIRD STREET",
            "address_2": "NO 975W",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900486101",
            "telephone_number": "310-652-0530",
            "fax_number": "310-652-9936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT J. MCKENNA JR. MD, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-10-11",
        "status": "A",
        "authorized_official_last_name": "MCKENNA",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "310-652-0530",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G39081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0091070",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; 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.