Active NPI
Jennifer Khedia
- Clinical Social Worker
- Los Angeles, CA
National Provider Identifier
1962042135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 87890
- Practice address
- 333 S Beaudry Ave
Los Angeles, CA 90017-1466 - Phone
- (213) 241-3841
- NPI assigned
- Jan 15, 2020
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 87890 | CA | Primary |
| Mental Health Counselor | 101YM0800X |
Addresses
Primary practice location
333 S Beaudry Ave
Los Angeles, CA 90017-1466
Mailing address
333 S Beaudry Ave
Los Angeles, CA 90017-1466
Other names 1
- Jennifer Stark
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 |
|---|---|---|---|
| 87890 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743465600000",
"number": "1962042135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 S BEAUDRY AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900171466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 S BEAUDRY AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900171466",
"telephone_number": "213-241-3841"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHEDIA",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-15",
"last_updated": "2025-04-01",
"certification_date": "2025-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "87890",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "STARK",
"code": "1",
"type": "Former Name"
}
]
}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 Apr 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.