Kenzie Jamal Moore, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

5954 Edgemar Ave
Los Angeles, CA 90043-3452

Phone

(323) 559-1541

NPI assigned

Apr 11, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1365638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365638400000",
    "number": "1932542636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5954 EDGEMAR AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900433452",
            "telephone_number": "323-559-1541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5954 EDGEMAR AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900433452",
            "telephone_number": "323-559-1541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KENZIE",
        "middle_name": "JAMAL",
        "name_prefix": "Mr.",
        "credential": "IDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-11",
        "last_updated": "2013-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Moore
• Julie Moore
• Kathryn Walker Moore, PH.D.
• Kelly Moore
• Kellye Moore
• Kim Marie Moore, FNP-C
• Kimberly Diane Moore
• Kolesta L Moore
• Kristen Moore
• Lakasha Deshun Moore

• Independent Duty Corpsman in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Independent Duty Corpsman in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.

Verify at the official NPI Registry.