Active NPI
Kevin Ly
- Community Health Worker
- Los Angeles, CA
National Provider Identifier
1710717947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 3350 W 1St St
Los Angeles, CA 90004-6000 - Phone
- (213) 289-3578
- NPI assigned
- Aug 2, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
3350 W 1St St
Los Angeles, CA 90004-6000
Mailing address
207 1/2 N Avenue 56
Highland Park, CA 90042-4113
Phone (714) 316-4249
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Painted Brain | Community Health Worker | Current | Accepting new patients |
Locations
3350 W 1st St
Los Angeles, CA 90004
Phone (213) 289-3573
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Los Angeles, CA
- NPI 1427810548
Community Health Worker
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724025600000",
"number": "1710717947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 1/2 N AVENUE 56",
"city": "HIGHLAND PARK",
"state": "CA",
"postal_code": "900424113",
"telephone_number": "714-316-4249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3350 W 1ST ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900046000",
"telephone_number": "213-289-3578"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "KEVIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-02",
"last_updated": "2024-08-19",
"certification_date": "2024-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.