Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
KENNETH LANDIS M D A MEDICAL CORPORATION
Active
Organization
KENNETH LANDIS M D A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH WAYNE LANDIS M.D. (PRESIDENT)
(310) 822-2255
Entity
Organization
Contact information
Practice address
4644 LINCOLN BLVD, SUITE 500, MARINA DEL REY, CA 90292-6313
(310) 822-2255
(310) 822-0044
Mailing address
4644 LINCOLN BLVD, SUITE 500, MARINA DEL REY, CA 90292-6313
(310) 822-2255
(310) 822-0044
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G29787
CA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
G29787
CA
207RP1001X
Pulmonary Disease Physician
G29787
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G297870
—
CA
05
—
00G297871
—
CA
01
—
290003222
RAILROAD MEDICARE
CA
01
—
CP9010
MEDICARE RRR
—
Enumeration date
11/21/2006
Last updated
04/20/2017
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up