1013952159 NPI number — KENITH K PARESA MD

Table of content: KENITH K PARESA MD (NPI 1013952159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013952159 NPI number — KENITH K PARESA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARESA
Provider First Name:
KENITH
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013952159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11740 SAN VICENTE BLVD # 109440
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90049-6610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-659-9566
Provider Business Mailing Address Fax Number:
310-360-6777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11600 WILSHIRE BLVD STE 406
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-1785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-248-8325
Provider Business Practice Location Address Fax Number:
310-943-2161
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  A66233 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A662330 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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