| 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 |
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