Provider Demographics
NPI:1083826382
Name:KAFKA, KENNETH ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ROY
Last Name:KAFKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 CARRILLO DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5400
Mailing Address - Country:US
Mailing Address - Phone:310-888-7778
Mailing Address - Fax:323-938-1028
Practice Address - Street 1:955 CARRILLO DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5400
Practice Address - Country:US
Practice Address - Phone:310-888-7778
Practice Address - Fax:323-938-1028
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86040207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine