KEDREN COMMUNITY CARE CLINIC - B NPI 1295257913

NPI Information

NPI: 1295257913
Provider Name: KEDREN COMMUNITY CARE CLINIC - B
Classification: Clinic/Center - 261QF0400X
Specialization: Federally Qualified Health Center (FQHC)
Entity Type: Organization
:
CLIA Number: 05D2068132
Address: 4211 AVALON BLVD BLDG B
LOS ANGELES, CA
ZIP 90011
Phone: (323) 234-0616

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NPI Details

KEDREN COMMUNITY CARE CLINIC - B is a federally qualified health center (fqhc) clinic center in Los Angeles, CA. KEDREN COMMUNITY CARE CLINIC - B NPI is 1295257913. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

4211 AVALON BLVD BLDG B
LOS ANGELES, CA
ZIP 90011-622
Phone: (323) 234-0616
Fax: (323) 515-7006

The provider's authorized official is Jason Alexander Warner .
The authorized official title is Chief Information Officer and has the following contact phone number (323) 515-7010.

The CLIA number assigned to this NPI record is 05D2068132 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/14/2017 and was last updated on 2/11/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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