Active NPI
Keith Glenn Kenworthy, LVN,PHLEBOTOMIST
- Phlebotomy Technician
- Los Angeles, CA
National Provider Identifier
1871831453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Phlebotomy Technician
- License
- CPT00040181
- Practice address
- 1764 N Orange Dr
Los Angeles, CA 90028-4307 - Phone
- (323) 491-4765
- NPI assigned
- Jan 16, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | VN 267760 | CA | |
| Phlebotomy Technician | 246RP1900X | CPT00040181 | CA | Primary |
Addresses
Primary practice location
1764 N Orange Dr
Los Angeles, CA 90028-4307
Mailing address
1764 N Orange Dr
Los Angeles, CA 90028-4307
Phone (323) 491-4765
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 |
|---|---|---|---|
| VN 267760 | CA | MD | Licensed Vocational Nurse |
| CPT00040181 | CA | MD | Phlebotomy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358294400000",
"number": "1871831453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1764 N ORANGE DR",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900284307",
"telephone_number": "323-491-4765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1764 N ORANGE DR",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900284307",
"telephone_number": "323-491-4765"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENWORTHY",
"first_name": "KEITH",
"middle_name": "GLENN",
"name_prefix": "Mr.",
"credential": "LVN,PHLEBOTOMIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-01-16",
"last_updated": "2013-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "CA",
"license": "VN 267760",
"primary": false
},
{
"code": "246RP1900X",
"taxonomy_group": "",
"desc": "Technician, Pathology, Phlebotomy",
"state": "CA",
"license": "CPT00040181",
"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 Jan 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.