NPIMap

Individual provider Active NPI

Kenneth Earl Holliman, M.D.

  • Obstetrics & Gynecology Physician
  • Torrance, CA
National Provider Identifier
1861445645
Registry record updated Feb 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
C39719 Issued in CA
Practice address
23600 Telo Ave Ste 250
Torrance, CA 90505-4037
Phone
(310) 375-8446
Fax
(310) 602-5053
NPI assigned
May 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X C39719 CA Primary

Addresses

Primary practice location

23600 Telo Ave Ste 250
Torrance, CA 90505-4037

Mailing address

PO Box 3129
Torrance, CA 90510-3129
Phone (310) 792-3914

Other identifiers 1

IdentifierTypeStateIssuer
1568604965MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040213000307 CA Practitioner - Obstetrics/Gynecology 3274427703 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Texas Medical School at San Antonio, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical InstituteGroup PAC ID 5991609737, 303 clinicians

Practice addresses (Care Compare)

20911 Earl St
Suite 440
Torrance, CA 90503-4355
Phone (310) 419-8585

23600 Telo Ave
Suite 250
Torrance, CA 90505-4037
Phone (310) 375-8446

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of the uterus49

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Institute Obstetrics & Gynecology CurrentSince Sep 29, 2018 Accepting new patients
Providence Medical Institute Obstetrics & Gynecology CurrentSince Sep 29, 2018 Accepting new patients
Tmogi Inc Obstetrics & Gynecology CurrentSince Nov 29, 2017 Accepting new patients
Providence Health System - Southern California Past Accepting new patients
Providence Health System Southern California Past Accepting new patients
La Vida Multispecialty Medical Group Inc Past Accepting new patients
Prairie Medical Group Past Accepting new patients
La Vida Multi-Specialty Medical Group Past Accepting new patients
Torrance Memorial Medical Center Past Accepting new patients

Locations

11539 Hawthorne Blvd
Ste F
Hawthorne, CA 90250

20911 Earl St
Ste 440
Torrance, CA 90503
Phone (310) 419-8585

3330 Lomita Blvd
Torrance, CA 90505
Phone (310) 517-4675

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: kholliman191857@oc.providencedirect.org

Organizations & group practices 10

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 2

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": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1861445645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3129",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905103129",
            "telephone_number": "310-792-3914",
            "fax_number": "855-898-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23600 TELO AVE STE 250",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905054037",
            "telephone_number": "310-375-8446",
            "fax_number": "310-602-5053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLIMAN",
        "first_name": "KENNETH",
        "middle_name": "EARL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "C39719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1568604965",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Torrance, CA

Sources for this page

Verify at the official NPI Registry.