Kenneth Wayne Landis, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

G29787 Issued in CA

Practice address

4477 W 118TH St Ste 401
Hawthorne, CA 90250-2269

Phone

(310) 822-2255

Fax

(310) 970-1979

NPI assigned

Jan 27, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 3

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 MedicineAlso: Pulmonary Disease

Education

University of California, Geffen School of Medicine, 1974

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cedar-Sinai Marina del Rey Hospital Hospital, Marina del Rey, CA, CCN 050740

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.

• Kenneth Landis M D a Medical Corporation

  • Internal Medicine Physician
  • Marina del Rey, CA
  • NPI 1184799520
  Medicare reassignment NPD Authorized official
• Cedars-Sinai Marina Hospital

  • General Acute Care Hospital
  • Marina del Rey, CA
  • NPI 1942269725
  NPD (past)
• Prime Healthcare Centinela, LLC

  • General Acute Care Hospital
  • Inglewood, CA
  • NPI 1336328244
  NPD (past)

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

• Cedars-Sinai Marina Hospital

  • General Acute Care Hospital
  • Marina del Rey, CA
  • NPI 1942269725
  Care Compare affiliation

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573689600000",
    "number": "1861463077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4477 W 118TH ST STE 401",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902502269",
            "telephone_number": "310-822-2255",
            "fax_number": "310-970-1979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4477 W 118TH ST STE 401",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902502269",
            "telephone_number": "310-822-2255",
            "fax_number": "310-970-1979"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4644 Lincoln Blvd",
            "address_2": "Suite 500",
            "address_purpose": "LOCATION",
            "city": "Marina Del Rey",
            "state": "CA",
            "postal_code": "902926313",
            "country_code": "US",
            "telephone_number": "310-822-2255",
            "fax_number": "310-822-0044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANDIS",
        "first_name": "KENNETH",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-27",
        "last_updated": "2019-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "CA",
            "license": "G29787",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "G29787",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G29787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD RETIREMENT BOARD",
            "identifier": "290003222",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G297870",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CP9010",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• La Vida Multi-Specialty Medical Group
• La Vida Multispecialty Medical Group Inc
• Jamie Marie Lacroix, SLPA
• Jessica Michelle Lam, DMD
• Donald Land, SUD COUNSELOR
• Jordan Joseph Langro
• Ricardo Ignacio Lanza Jr., RN
• Brendan Lascala, OTR/L
• Yaniset Delia Lastra Martin
• Melissa Luis Laureola, D.D.S.

• Internal Medicine Physician in Hawthorne, CA
• Providers in Hawthorne, 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 Nov 14, 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.