Kenneth Pettersen, MD, MPH

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A147825 Issued in CA

Practice address

14445 Olive View Dr # 2D-154
Sylmar, CA 91342-1437

Phone

(747) 210-4990

Fax

(747) 210-4573

NPI assigned

Mar 25, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Internal Medicine

Education

University of California, San Francisco School of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of Los AngelesGroup PAC ID 1850296534, 395 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lac/Olive View-UCLA Medical Center Hospital, Sylmar, CA, CCN 050040

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• County of Los Angeles

  dba County of Los Angeles Harbor UCLA Medical Center

  • General Acute Care Hospital
  • Torrance, CA
  • NPI 1851363188
  Medicare reassignment Care Compare group NPD
• County of Los Angeles

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1295407401
  NPD
• County of Los Angeles Auditor Controller

  dba Los Angeles County Olive View-UCLA Medical Center

  • General Acute Care Hospital
  • Sylmar, CA
  • NPI 1134159320
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• County of Los Angeles

  dba Los Angeles County Olive View-UCLA Medical Center

  • General Acute Care Hospital
  • Sylmar, CA
  • NPI 1134143415
  Care Compare affiliation

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

{
    "created_epoch": "1427241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577750400000",
    "number": "1710371927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14445 OLIVE VIEW DR # 2B182",
            "city": "SYLMAR",
            "state": "CA",
            "postal_code": "913421438",
            "telephone_number": "747-210-3205",
            "fax_number": "747-210-4573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14445 OLIVE VIEW DR # 2D-154",
            "city": "SYLMAR",
            "state": "CA",
            "postal_code": "913421437",
            "telephone_number": "747-210-4990",
            "fax_number": "747-210-4573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTERSEN",
        "first_name": "KENNETH",
        "credential": "MD, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-25",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A147825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Larissa Guadalupe Perez
• Philip Mojica Perez
• Yadira Baney Perez, RN
• Kimberly C. Peterson, M.D.
• Sheffra Peterson
• Margaret Pettibone, MD
• Annette Van Anh Pham, NP
• Phuong CHI T Pham, MD
• Steven Pham, DO
• Huy Phan

• Internal Medicine Physician in Sylmar, CA
• Providers in Sylmar, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.