DR. KENNETH WAYNE LANDIS (NPI# 1861463077) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861463077 |
| Entity Type | Individual |
| Full Name | DR. KENNETH WAYNE LANDIS |
| Credential | M.D. |
| Practice Address |
4477 W 118th St Ste 401 Hawthorne CA 90250-2269 |
| Practice Telephone | 3108222255 |
| Practice Fax Number | 3109701979 |
| Mailing Telephone | 3108222255 |
| Mailing Fax Number | 3109701979 |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2019-11-14 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | G29787 | CA | Allopathic & Osteopathic Physicians |
| N | 207RC0200X |
Internal Medicine Specialization: Critical Care Medicine |
G29787 | CA | Allopathic & Osteopathic Physicians |
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
G29787 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00G297870 | 05 | |
| CA | RAILROAD MEDICARE | CP9010 | 01 |
| RAILROAD RETIREMENT BOARD | 290003222 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4644 Lincoln Blvd, Suite 500, Marina Del Rey, CA 902926313 | 3108222255 | 3108220044 |
| Street Address |
4477 W 118TH ST STE 401 |
| City | HAWTHORNE |
| State | CA |
| Zip Code | 90250-2269 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356483861 | Drayton P Graham | Internal Medicine | 4477 W 118th St Ste 401, Hawthorne, CA 90250-2269 | 2007-02-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508479627 | Alexis Lemmon | Dental Hygienist | 13450 Hawthrone Blvd, Hawthorne, CA 90250 | 2020-08-28 |
| 1336620459 | Lan Ngoc Ton | Dentist | 13450 S. Hawthorne Blvd, Hawthorne, CA 90250 | 2018-08-27 |
| 1356829261 | Karneth Health Inc | Internal Medicine | 4512 W. Imperial Hwy, Ste B, Hawthorne, CA 90250 | 2018-08-02 |
| 1225524663 | Viridian Healthcare LLC | In Home Supportive Care | 13658 Hawthorne Blvd Ste 201, Hawthorne, CA 90250 | 2018-07-09 |
| 1235636044 | Sonia Medical Center Inc | Clinic/Center | 4512 W Imperial Hwy, Hawthorne, CA 90250 | 2018-04-09 |
| 1518484807 | Jessica Anne-marie Auzenne-harris | Nurse Practitioner | 12618 Hawthorne Blvd, Hawthorne, CA 90250 | 2017-08-28 |
| 1669993358 | Ololade Olamide Obafemi | Nurse Practitioner | 12954 Hawthorne Boulevard, Suite 104, Hawthorne Morningside Medical Clinic, Hawthorne, CA 90250 | 2017-07-03 |
| 1588194534 | Marissam Medical Inc. | Durable Medical Equipment & Medical Supplies | 13508 Inglewood Ave, Hawthorne, CA 90250 | 2017-06-13 |
| 1043751886 | Ogbonna Iwuamadi Olelewe | Nurse Practitioner | 11712 S. Hawthorne Blvd, Hawthorne, CA 90250 | 2017-03-13 |
| 1952758898 | La Shada Kai Martin | Contractor | 13010 Kornblum Ave, Unit D, Hawthorne, CA 90250 | 2016-05-20 |
| Find all providers in zip 90250 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356829261 | Karneth Health Inc | Internal Medicine | 4512 W. Imperial Hwy, Ste B, Hawthorne, CA 90250 | 2018-08-02 |
| 1922470392 | One Medical Group, Inc. | Internal Medicine | 3615 Jack Northrop Ave., Suite 100, Hawthorne, CA 90250 | 2015-10-26 |
| 1790022556 | Marie Louise Mannino | Internal Medicine | 91 Mountain Ave, Hawthorne, NJ 07506-3331 | 2013-01-13 |
| 1104111756 | George Thomas Mathew | Internal Medicine | 500 Sherman Ave, Hawthorne, NY 10532-1320 | 2011-06-11 |
| 1356501134 | Erika Felicia Brutsaert | Internal Medicine | 19 Bradhurst Ave Ste 3060n, Hawthorne, NY 10532 | 2008-06-14 |
| 1427257583 | M M Medical Associates LLC | Internal Medicine | 29 Mountain Ave, Hawthorne, NJ 07506-3309 | 2007-07-17 |
| 1336205442 | Augustine Iluore | Internal Medicine | 11633 Hawthorne Blvd Ste 103, Hawthorne, CA 90250-2323 | 2007-01-01 |
| 1982770350 | Robert Steven Nicoloff | Internal Medicine | 5346 W 137th Pl, Hawthorne, CA 90250-6426 | 2006-11-28 |
| 1902996283 | Alexander R Mazziotti | Internal Medicine | 268 Lincoln Ave, Hawthorne, NJ 07506-1201 | 2006-10-15 |
| 1164526224 | Malay R Das | Internal Medicine | 4477 W 118th Street, Suite 409, Hawthorne, CA 90250 | 2006-09-11 |
| Find all providers in HAWTHORNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.