Active NPI
Kendall Green
- Physical Therapist
- West Hollywood, CA
National Provider Identifier
1720709504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT302460
- Practice address
- 8354 Santa Monica Blvd
West Hollywood, CA 90069-4313 - Phone
- (925) 430-6630
- NPI assigned
- Sep 8, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT302460 | CA | Primary |
Addresses
Primary practice location
8354 Santa Monica Blvd
West Hollywood, CA 90069-4313
Mailing address
11964 Kiowa Ave Apt 16
Los Angeles, CA 90049-5983
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT302460 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1662595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703635200000",
"number": "1720709504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11964 KIOWA AVE APT 16",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900495983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8354 SANTA MONICA BLVD",
"city": "WEST HOLLYWOOD",
"state": "CA",
"postal_code": "900694313",
"telephone_number": "925-430-6630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "KENDALL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-08",
"last_updated": "2023-12-27",
"certification_date": "2023-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT302460",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Hollywood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.