Individual
KENDEL THIRLBENNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
540 E ARTESIA BLVD, LONG BEACH, CA 90805-1476
(562) 423-3383
(877) 469-3649
Mailing address
200 OCEANGATE, SUITE 100, LONG BEACH, CA 90802-4302
(562) 499-6191
(877) 469-3649
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 16098
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EFF: 1/18/2013
—
CA
01
—
P01272662/DU4032
RAILROAD MEDICARE
CA
01
—
P01273082
RAILROAD MEDICARE-DU4032-WILMINGTON
CA
05
—
PA16098
—
CA
Enumeration date
01/05/2007
Last updated
04/16/2015
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