Provider Demographics
NPI:1588663603
Name:MARR, KENDALL CHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:CHEN
Last Name:MARR
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 1:23101 SHERMAN PL
Mailing Address - Street 2:#500
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-2003
Mailing Address - Country:US
Mailing Address - Phone:818-676-4808
Mailing Address - Fax:818-676-4810
Practice Address - Street 1:23101 SHERMAN PL
Practice Address - Street 2:#500
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2003
Practice Address - Country:US
Practice Address - Phone:818-676-4808
Practice Address - Fax:818-676-4810
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33725207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060065500OtherRR MEDICARE
060065500OtherRR MEDICARE
G33725Medicare ID - Type Unspecified