| Kenneth Landis M D A Medical Corporation | |
|
4644 Lincoln Blvd Suite 500 Marina Del Rey CA 90292-6313 | |
| (310) 822-2255 | |
| (310) 822-0044 |
| Full Name | Kenneth Landis M D A Medical Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 4644 Lincoln Blvd, Marina Del Rey, California |
| Authorized Official Name and Position | Kenneth Wayne Landis (PRESIDENT) |
| Authorized Official Contact | 3108222255 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth Landis M D A Medical Corporation 4644 Lincoln Blvd Suite 500 Marina Del Rey CA 90292-6313 Ph: (310) 822-2255 | Kenneth Landis M D A Medical Corporation 4644 Lincoln Blvd Suite 500 Marina Del Rey CA 90292-6313 Ph: (310) 822-2255 |
| NPI Number | 1184799520 |
|---|---|
| Provider Enumeration Date | 11/21/2006 |
| Last Update Date | 04/20/2017 |
| Medicare PECOS PAC ID | 4789863341 |
|---|---|
| Medicare Enrollment ID | O20110127001155 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184799520 | NPI | - | NPPES |
| 00G297871 | Medicaid | CA | |
| 290003222 | Other | CA | RAILROAD MEDICARE |
| CP9010 | Other | MEDICARE RRR | |
| 00G297870 | Medicaid | CA |
| Provider Name | Kenneth W Landis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861463077 PECOS PAC ID: 5799707493 Enrollment ID: I20051221001094 |
Jonathan D. Rand, M.d. Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4644 Lincoln Blvd, 113, Marina Del Rey, CA 90292 Phone: 310-821-9800 Fax: 310-306-0263 | |
Wound Pros Doctors Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4640 Admiralty Way Ste 500, Marina Del Rey, CA 90292 Phone: 818-836-2475 Fax: 323-433-9177 | |
Access Medical Group Of Mdr Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4644 Lincoln Blvd, #111, Marina Del Rey, CA 90292 Phone: 310-306-6966 Fax: 310-306-0667 | |
Carlo Medina Medical Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4560 Admiralty Way Ste 201, Marina Del Rey, CA 90292 Phone: 310-823-3443 Fax: 310-305-7470 | |
Etie Moghissi, Md,inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4644 Lincoln Blvd Ste 409, Marina Del Rey, CA 90292 Phone: 310-578-6747 Fax: 310-578-6750 | |
William G Lang Md A Professional Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4644 Lincoln Blvd., Suite 111, Marina Del Rey, CA 90292 Phone: 310-536-8200 Fax: 310-536-8240 |