Individual provider Active NPI

Athanasia Nancy Kakoyannis, D.O.

  • Family Medicine Physician
  • Venice, CA
National Provider Identifier
1982895371
Registry record updated Mar 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A10217 Issued in CA
Practice address
604 Rose Ave
Venice, CA 90291-2767
Phone
(310) 664-7685
NPI assigned
Aug 9, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A10217 CA Primary

Addresses

Primary practice location

604 Rose Ave
Venice, CA 90291-2767

Mailing address

604 Rose Ave
Venice, CA 90291-2767
Phone (310) 664-7685

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100416000673 CA Practitioner - Family PracticePractitioner - Osteopathic Manipulative Medicine 6204963671 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
10217CAMDAddiction (Substance Use Disorder) Counselor
20A10217CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Venice Family Clinic CurrentSince Feb 8, 2010 Accepting new patients
Venice Family Clinic Current Accepting new patients
Venice Family Clinic Current Accepting new patients
Venice Family Clinic Current Accepting new patients
Venice Family Clinic CurrentSince Feb 8, 2010 Accepting new patients

Locations

1091 S La Brea Ave
Inglewood, CA 90301
Phone (310) 330-2960

4700 Inglewood Blvd
Ste 102
Los Angeles, CA 90230
Phone (310) 664-7901

2509 Pico Blvd
Santa Monica, CA 90405
Phone (310) 664-7901

604 Rose Ave
Venice, CA 90291
Phone (310) 392-8630

905 Venice Blvd
Venice, CA 90291
Phone (310) 392-8630

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: nkakoyannis753498@direct.ochin.org
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1186617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268179200000",
    "number": "1982895371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 ROSE AVE",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912767",
            "telephone_number": "310-664-7685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 ROSE AVE",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912767",
            "telephone_number": "310-664-7685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAKOYANNIS",
        "first_name": "ATHANASIA",
        "middle_name": "NANCY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-09",
        "last_updated": "2010-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A10217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Venice, CA

Sources for this page

Verify at the official NPI Registry.