Provider Demographics
NPI:1346560455
Name:FIBEL, KENTON HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:KENTON
Middle Name:HOWARD
Last Name:FIBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:535 E 70TH ST
Mailing Address - Street 2:ATTENTION: KENTON FIBEL, MD
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4823
Mailing Address - Country:US
Mailing Address - Phone:646-714-6323
Mailing Address - Fax:646-714-6376
Practice Address - Street 1:6801 PARK TERRACE
Practice Address - Street 2:100, 125, 400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-9004
Practice Address - Country:US
Practice Address - Phone:310-665-7200
Practice Address - Fax:646-714-6376
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA118684207QS0010X
NY268986207QS0010X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program