Provider Demographics
NPI:1306034434
Name:KENNETH NAZARI MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:KENNETH NAZARI MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNTH
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-751-0777
Mailing Address - Street 1:501 E HARDY ST STE 160
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4033
Mailing Address - Country:US
Mailing Address - Phone:775-751-0777
Mailing Address - Fax:775-751-8777
Practice Address - Street 1:501 E HARDY ST
Practice Address - Street 2:#424
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4054
Practice Address - Country:US
Practice Address - Phone:775-751-0777
Practice Address - Fax:775-751-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW7157Medicare PIN
CAA27586Medicare UPIN