Individual provider Active NPI

Rene Nicole Kohlieber, M.D.

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1720377492
Registry record updated Apr 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A116238 Issued in CA
Practice address
4950 W Sunset Blvd
4TH Floor
Los Angeles, CA 90027-5822
Phone
(323) 783-7899
NPI assigned
Apr 4, 2011
Last updated
Apr 4, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A116238 CA Primary

Addresses

Primary practice location

4950 W Sunset Blvd
4TH Floor
Los Angeles, CA 90027-5822

Mailing address

4950 W Sunset Blvd
4TH Floor
Los Angeles, CA 90027-5822
Phone (323) 783-7899

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
I20140428001013 CA Practitioner - Family PracticePractitioner - Geriatric Medicine 5890928881 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
Albert Einstein College of Medicine of Yeshiva University, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Senior Care Clinic a Medical CorporationGroup PAC ID 6103872403, 4 clinicians

Practice addresses (Care Compare)

1700 Cesar Chavez Ave
Suite 3900
Los Angeles, CA 90033
Phone (323) 307-0800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A116238CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gerardo Canchola MD, Inc. General Practice CurrentSince Aug 11, 2024 Accepting new patients
Senior Care Clinic a Medical Corporation CurrentSince Nov 26, 2017 Accepting new patients
Gnosis Geriatric Wellcare Center Inc Family Medicine CurrentSince Sep 18, 2024 Accepting new patients
White Memorial Medical Center Past Accepting new patients

Locations

12555 Garden Grove Blvd
Ste 304
Garden Grove, CA 92843
Phone (714) 353-5333

1700 E Cesar E Chavez Ave
Ste 3900
Los Angeles, CA 90033
Phone (323) 307-0800

2621 S Bristol St
Ste 308
Santa Ana, CA 92704
Phone (714) 662-7710

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1301875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301875200000",
    "number": "1720377492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4950 W SUNSET BLVD",
            "address_2": "4TH FLOOR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900275822",
            "telephone_number": "323-783-7899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4950 W SUNSET BLVD",
            "address_2": "4TH FLOOR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900275822",
            "telephone_number": "323-783-7899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOHLIEBER",
        "first_name": "RENE",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-04",
        "last_updated": "2011-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A116238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.