Active NPI
Kenneth Ray Taylor, PA-C
- Physician Assistant
- Van Nuys, CA
National Provider Identifier
1891708376
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Aug 18, 2011.
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA-15549
- Practice address
- 16300 Roscoe Blvd
Van Nuys, CA 91406-1258 - Phone
- (818) 893-4426
- NPI assigned
- Aug 14, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-15549 | CA | Primary |
Addresses
Primary practice location
16300 Roscoe Blvd
Van Nuys, CA 91406-1258
Mailing address
10630 Sepulveda Blvd
Ste 100
Mission Hills, CA 91345-1937
Phone (818) 933-4440
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15549 | CA | MD | Chiropractor |
| PA-15549 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635897600000",
"number": "1891708376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10630 SEPULVEDA BLVD",
"address_2": "STE 100",
"city": "MISSION HILLS",
"state": "CA",
"postal_code": "913451937",
"telephone_number": "818-933-4440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16300 ROSCOE BLVD",
"city": "VAN NUYS",
"state": "CA",
"postal_code": "914061258",
"telephone_number": "818-893-4426"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAYLOR",
"first_name": "KENNETH",
"middle_name": "RAY",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2021-11-03",
"certification_date": "2021-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA-15549",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Van Nuys, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.