Individual
KENLI T BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COMMUNITY PEER
Contact information
Practice address
1225 W 190TH ST STE 280, GARDENA, CA 90248-4305
(877) 515-8113
Mailing address
1729 1/2 W ADAMS BLVD, LOS ANGELES, CA 90018-2702
(916) 730-6253
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
04/04/2024
Last updated
07/16/2025
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